![\"Step](\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_3-implement-1024x132.png\")
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- Nephrologist<\/strong>: Doctors who have advanced training in treating kidney disease<\/li>\r\n \t
- Nurse Practitioner<\/strong>: A registered nurse with advanced education to be able to assess, diagnose, treat and monitor a wide range of health problems<\/li>\r\n \t
- Nephrology Nurse<\/strong>: A nurse with specialized experience in the care of patients with chronic kidney disease.<\/li>\r\n \t
- Social Worker<\/strong>: Provide counselling and identify sources of emotional support for patients and their families cope with kidney disease<\/li>\r\n \t
- Pharmacist<\/strong>: Review the patient\u2019s medication orders for appropriateness and ensure that the right medication and the right dose is administered<\/li>\r\n \t
- Patient Care Technician and\/or Renal Technologist<\/strong>: Responsible for the education, maintenance and cleaning of renal equipment, such as dialysis machines.<\/li>\r\n<\/ul>\r\n[h5p id=\"9\"]<\/span>\r\n\r\n \r\n
\r\n Liaising with Raymond's Team<\/h2>\r\n<\/header>\r\n
\r\nIn Raymond's case, you can liaise with:<\/div>\r\n- \r\n \t
- The nurse practitioner and\/or nephrologist about Raymond's fluid restriction<\/li>\r\n \t
- The nephrologist, nurse practitioner, and\/or nurse regarding the changes to Raymond\u2019s diet order<\/li>\r\n \t
- Liaise with the nephrologist and pharmacist to start 1 tab calcium-based phosphate binder daily with dinner (his largest meal), since it is not within the RD scope of practice to prescribe phosphate binders<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/div>\r\n
Education<\/h1>\r\nWhen implementing your plan, you will spend some time speaking with the patient about kidney disease and the dietary changes they may have to make. When providing education to patients try to:\r\n
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- Individualize the education as much as possible,<\/strong> based on their stage of kidney disease and labs. If the patient\u2019s potassium and phosphorus is not elevated, then no K\/PO4<\/sub> intervention is required at that time, and you can continue to monitor<\/li>\r\n \t
- Find out if patient has had previous education: <\/strong>Ask the patient if any one else has talked to them about their diet and kidney disease. If the patient is followed by another renal dietitian, it might be worthwhile to reach out to them to gain additional information about the patient\u2019s situation and provide a summary of your nutrition interventions while in hospital.<\/li>\r\n \t
- Focus on a few key messages: <\/strong>If the patient is newly diagnosed or doesn\u2019t know much about kidney disease, try not to overwhelm them with too much information during your first couple of interactions<\/li>\r\n<\/ul>\r\nThink of some key messages you might want to speak to Raymond about when providing education as you implement the nutrition care plan.\r\n
\r\n Raymond's Education - Key Messages<\/h2>\r\n<\/header>\r\n
\r\n\r\nBefore implementing the diet order, you need to meet with Raymond to go over the plan with him. In your meeting with him, you can explain the reasons for the dietary changes and what that means in terms of the types of foods he will be receiving while he is in the hospital. When you ask him if he has been told to make diet changes before, he tells you the only thing he remembers is that his family doctor has told him many times to cut back on the amount of salt he is eating because of his history of high blood pressure.\r\n\r\nYou decide to talk to him about 3 key messages related to the changes to his diet:\r\n- \r\n \t
- Your kidneys are not able to filter enough fluid and salt from your blood. So when you drink a lot of fluid and eat too much salt, the fluid builds up in your ankles, making them swollen. To try to reduce the swelling, you will get foods that are lower in salt and only get about 6 cups of fluid to drink in a day.<\/li>\r\n \t
- Some foods, like processed meat, cheese, and milk contain higher amounts of phosphorus. You won\u2019t get these foods very often on your tray at the hospital because your kidneys cannot process a large amount of phosphorus.<\/li>\r\n \t
- Your kidneys are also not able to process high amounts of protein, which is why you may receive smaller portions of meat in your meals than you are used to having.<\/li>\r\n<\/ol>\r\nPractice explaining the three key messages in plain language.\r\n\r\n<\/div>\r\n<\/div>\r\n
Using analogies<\/h2>\r\nI<\/span>t can also be helpful to use simple analogies. For example, kidneys are like oil filters in cars. In <\/span>using this analogy to help educate a client about kidney disease, you could say:\r\n
\r\n\r\n\"In our bodies, the kidneys\u2019 role is to clean and filter our blood, kind of like how cars need filters to clean the oil that moves throughout the engine to keep it running. Sometimes when filters get old or they break they are not able to filter the oil properly. This is what happens when you have kidney disease since your kidneys can no longer clean the blood the way they used to, so we need to make some changes to ensure your body can still function.\"\r\n\r\n<\/div>\r\n\r\n[caption id=\"attachment_540\" align=\"alignnone\" width=\"1024\"]![\"The](\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/01\/engine-g43cfa6b10_1920-1024x576.jpg\")
Image by nastogadka via Pixabay<\/a>[\/caption]\r\nSupporting Change<\/h1>\r\nOngoing management of a chronic disease can lead to burnout, and making dietary changes may be difficult for some patients. To help support them in making these changes, you may want to try:\r\n
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- Motivational interviewing:\u00a0<\/span><\/strong>collect their story, listen reflectively, collaborate rather than convince<\/li>\r\n \t
- [pb_glossary id=\"1443\"]SMART goal [\/pb_glossary] setting:\u00a0<\/span><\/strong>help to identify barriers to change as part of creating a nutrition care plan with the client<\/li>\r\n \t
- Referral to social worker:<\/strong>\u00a0<\/span>consider referring them to a social worker if they need someone to talk to about coping with the burden of managing a chronic disease<\/li>\r\n<\/ul>\r\nIn Raymond\u2019s case, he could set some SMART goals as part of his discharge plan on how he can reduce his sodium, protein, phosphorus and fluid intake once he returns home.\r\n\r\nThink about some SMART goals that you could set in collaboration with Raymond.\r\n
- [pb_glossary id=\"1443\"]SMART goal [\/pb_glossary] setting:\u00a0<\/span><\/strong>help to identify barriers to change as part of creating a nutrition care plan with the client<\/li>\r\n \t
- Motivational interviewing:\u00a0<\/span><\/strong>collect their story, listen reflectively, collaborate rather than convince<\/li>\r\n \t
- Find out if patient has had previous education: <\/strong>Ask the patient if any one else has talked to them about their diet and kidney disease. If the patient is followed by another renal dietitian, it might be worthwhile to reach out to them to gain additional information about the patient\u2019s situation and provide a summary of your nutrition interventions while in hospital.<\/li>\r\n \t
- Individualize the education as much as possible,<\/strong> based on their stage of kidney disease and labs. If the patient\u2019s potassium and phosphorus is not elevated, then no K\/PO4<\/sub> intervention is required at that time, and you can continue to monitor<\/li>\r\n \t
- Nurse Practitioner<\/strong>: A registered nurse with advanced education to be able to assess, diagnose, treat and monitor a wide range of health problems<\/li>\r\n \t