{"id":405,"date":"2021-12-02T14:05:49","date_gmt":"2021-12-02T19:05:49","guid":{"rendered":"https:\/\/pressbooks.library.ryerson.ca\/dietmods\/?post_type=chapter&#038;p=405"},"modified":"2024-08-15T14:57:23","modified_gmt":"2024-08-15T18:57:23","slug":"renal-evaluate","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/renal-evaluate\/","title":{"raw":"Evaluate","rendered":"Evaluate"},"content":{"raw":"<pre><img src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_4-evaluate-1024x132.png\" alt=\"Step 4: Evaluate\" width=\"1024\" height=\"132\" class=\"alignnone wp-image-1370 size-large\" \/><\/pre>\r\n<h1>Evaluating the Nutrition Care Plan<\/h1>\r\nAfter you have implemented the plan, you want to follow-up and evaluate it to see if it has been effective in addressing your nutrition concerns. This can help you to decide on appropriate changes to make to the nutrition care plan moving forward. When evaluating your plan in an inpatient setting, you will need to gather updated information from the same key areas of nutrition concern that you identified in your initial assessment.\r\n\r\nIn populations with chronic kidney disease, the three main areas to commonly re-assess include:\r\n<ol>\r\n \t<li>Malnutrition<\/li>\r\n \t<li>Abnormal electrolytes<\/li>\r\n \t<li>Fluid overload<\/li>\r\n<\/ol>\r\n<table class=\"grid\" style=\"width: 100%\">\r\n<tbody>\r\n<tr style=\"height: 29px\">\r\n<th style=\"height: 29px;width: 172.516px\" scope=\"col\">Common Nutrition Issues<\/th>\r\n<th style=\"height: 29px;width: 486.375px\" scope=\"col\">Evaluate effectiveness of NCP<\/th>\r\n<\/tr>\r\n<tr style=\"height: 60px\">\r\n<th style=\"height: 60px;width: 172.516px\" scope=\"row\">Malnutrition<\/th>\r\n<td style=\"height: 60px;width: 486.375px\">\r\n<ul>\r\n \t<li>Has weight increased?<\/li>\r\n \t<li>Improvements in appetite?<\/li>\r\n \t<li>Increased protein or caloric intake from diet history?<\/li>\r\n \t<li>Improvements in pre-dialysis urea? (for dialysis pts)<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 60px\">\r\n<th style=\"height: 60px;width: 172.516px\" scope=\"row\">Abnormal Electrolytes<\/th>\r\n<td style=\"height: 60px;width: 486.375px\">\r\n<ul>\r\n \t<li>If hyper\/hypo-kalemic, can ask for a repeat of serum potassium<\/li>\r\n \t<li>If hyper\/hypo-phosphatemic, can ask for a repeat of serum phosphorus<\/li>\r\n \t<li>If taking phosphate binders, can ask for repeat calcium and phosphorus<\/li>\r\n \t<li>Appropriate changes in diet and\/or nutrition knowledge?<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"height: 30px\">\r\n<th style=\"height: 30px;width: 172.516px\" scope=\"row\">Fluid Overload<\/th>\r\n<td style=\"height: 30px;width: 486.375px\">\r\n<ul>\r\n \t<li>Improvements in fluid\/sodium intake from diet history?<\/li>\r\n \t<li>Improvements in edema, weights, [pb_glossary id=\"1648\"]SOB[\/pb_glossary], [pb_glossary id=\"1649\"]IDWG[\/pb_glossary] (if on dialysis)?<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\">Evaluating Raymond's Nutrition Care Plan<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\nWhen assessing Raymond\u2019s status after the implementation of your nutrition care plan, you want to see if his phosphorus levels are WNL since he was previously hyperphosphatemic, so you request a repeat for serum phosphorus. You also decided to start a calcium based phosphate binder after liaising with the team, so you\u2019ll want to request a calcium level as well. Finally you\u2019ll want to check his fluid status by seeing if there have been any improvements in his edema.\r\n\r\nThe results of the lab work you requested show that his serum phosphorus is 1.42 and is now WNL, but his calcium went up slightly to 2.55 as a result of starting the calcium-based phosphate binders. This means you\u2019ll have to keep an eye on his calcium and switch to a non-calcium based binder if it continues to rise. There has also been slight improvements in his ankle edema. As part of the plan you will continue the fluid restriction and low sodium diet and continue to monitor his fluid status and edema.\r\n\r\nKeep in mind that another part of evaluation that occurs in outpatient settings is following up with the patient regarding the SMART goals they set.\r\n<table class=\"grid\">\r\n<tbody>\r\n<tr>\r\n<th style=\"width: 146.712px\" scope=\"col\">Common Nutrition Issues<\/th>\r\n<th style=\"width: 407.913px\" scope=\"col\">Evaluate effectiveness of NCP<\/th>\r\n<th style=\"width: 344.05px\" scope=\"col\">Outcome<\/th>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 146.712px\" scope=\"row\">Malnutrition<\/th>\r\n<td style=\"width: 407.913px\">No concerns at this time<\/td>\r\n<td style=\"width: 344.05px\">-<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 146.712px\" scope=\"row\">Abnormal Electrolytes<\/th>\r\n<td style=\"width: 407.913px\">\r\n<ul>\r\n \t<li>Previously hyperphosphatemic, so ask for a repeat of serum phosphorus<\/li>\r\n \t<li>Taking calcium-based phosphate binder, so ask for repeat calcium<\/li>\r\n<\/ul>\r\n<\/td>\r\n<td style=\"width: 344.05px\">\r\n<ul>\r\n \t<li>Serum PO4 = 1.42 mmol\/L (WNL)\r\n<ul>\r\n \t<li>Normal range: <span>0.8 - 1.49 mmol\/L for CKD<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li>Ca = 2.55 mmol\/L (up slightly from 2.4 mmol\/L on admission)\r\n<ul>\r\n \t<li>Normal range: 2.1 - 2.6 mmol\/L for CKD<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 146.712px\" scope=\"row\">Fluid Overload<\/th>\r\n<td style=\"width: 407.913px\">\r\n<ul>\r\n \t<li>Improvements in fluid\/sodium intake from diet history?<\/li>\r\n \t<li>Improvements in edema?<\/li>\r\n<\/ul>\r\n<\/td>\r\n<td style=\"width: 344.05px\">\r\n<ul>\r\n \t<li>Slight improvements<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\n<\/div>\r\n<div>\r\n<div>\r\n<h1>The Nutrition Care Process Model<\/h1>\r\n<\/div>\r\n<div>\r\n\r\nAs you use the Nutrition Care Process Model and the learning from this case study as a guide throughout your patient care in practicum, please keep in mind that the process is dynamic, and not step-by-step as all cases are different. You are encouraged to complete the recommended readings for this module and continue to expand your learning in this clinical area of practice.\r\n\r\n<\/div>\r\n<div class=\"textbox shaded\">\r\n\r\nPART 4: EVALUATE COMPLETE. Pause to reflect on the evaluation strategies discussed, and review the readings and resources in the following section for your information.\r\n\r\nYou\u2019ve now completed the Renal nutrition module. Please consider providing feedback through the embedded form in the next section.\r\n\r\n<\/div>\r\n<h1>Acknowledgements<\/h1>\r\n<\/div>\r\nArti Sharma Parpia, RD, MSc\r\nJess Wiles, RD, MHSc(c)\r\n\r\n&nbsp;","rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Page Contents<\/p>\n<label for=\"ez-toc-cssicon-toggle-item-69d142a34550e\" class=\"ez-toc-cssicon-toggle-label\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/label><input type=\"checkbox\"  id=\"ez-toc-cssicon-toggle-item-69d142a34550e\" checked aria-label=\"Toggle\" \/><nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/renal-evaluate\/#Evaluating_the_Nutrition_Care_Plan\" >Evaluating the Nutrition Care Plan<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/renal-evaluate\/#Evaluating_Raymonds_Nutrition_Care_Plan\" >Evaluating Raymond&#8217;s Nutrition Care Plan<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/renal-evaluate\/#The_Nutrition_Care_Process_Model\" >The Nutrition Care Process Model<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/chapter\/renal-evaluate\/#Acknowledgements\" >Acknowledgements<\/a><\/li><\/ul><\/nav><\/div>\n<pre><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_4-evaluate-1024x132.png\" alt=\"Step 4: Evaluate\" width=\"1024\" height=\"132\" class=\"alignnone wp-image-1370 size-large\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_4-evaluate-1024x132.png 1024w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_4-evaluate-300x39.png 300w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_4-evaluate-768x99.png 768w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_4-evaluate-1536x198.png 1536w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_4-evaluate-2048x264.png 2048w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_4-evaluate-65x8.png 65w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_4-evaluate-225x29.png 225w, https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-content\/uploads\/sites\/262\/2022\/02\/label_4-evaluate-350x45.png 350w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/pre>\n<h1><span class=\"ez-toc-section\" id=\"Evaluating_the_Nutrition_Care_Plan\"><\/span>Evaluating the Nutrition Care Plan<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>After you have implemented the plan, you want to follow-up and evaluate it to see if it has been effective in addressing your nutrition concerns. This can help you to decide on appropriate changes to make to the nutrition care plan moving forward. When evaluating your plan in an inpatient setting, you will need to gather updated information from the same key areas of nutrition concern that you identified in your initial assessment.<\/p>\n<p>In populations with chronic kidney disease, the three main areas to commonly re-assess include:<\/p>\n<ol>\n<li>Malnutrition<\/li>\n<li>Abnormal electrolytes<\/li>\n<li>Fluid overload<\/li>\n<\/ol>\n<table class=\"grid\" style=\"width: 100%\">\n<tbody>\n<tr style=\"height: 29px\">\n<th style=\"height: 29px;width: 172.516px\" scope=\"col\">Common Nutrition Issues<\/th>\n<th style=\"height: 29px;width: 486.375px\" scope=\"col\">Evaluate effectiveness of NCP<\/th>\n<\/tr>\n<tr style=\"height: 60px\">\n<th style=\"height: 60px;width: 172.516px\" scope=\"row\">Malnutrition<\/th>\n<td style=\"height: 60px;width: 486.375px\">\n<ul>\n<li>Has weight increased?<\/li>\n<li>Improvements in appetite?<\/li>\n<li>Increased protein or caloric intake from diet history?<\/li>\n<li>Improvements in pre-dialysis urea? (for dialysis pts)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 60px\">\n<th style=\"height: 60px;width: 172.516px\" scope=\"row\">Abnormal Electrolytes<\/th>\n<td style=\"height: 60px;width: 486.375px\">\n<ul>\n<li>If hyper\/hypo-kalemic, can ask for a repeat of serum potassium<\/li>\n<li>If hyper\/hypo-phosphatemic, can ask for a repeat of serum phosphorus<\/li>\n<li>If taking phosphate binders, can ask for repeat calcium and phosphorus<\/li>\n<li>Appropriate changes in diet and\/or nutrition knowledge?<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"height: 30px\">\n<th style=\"height: 30px;width: 172.516px\" scope=\"row\">Fluid Overload<\/th>\n<td style=\"height: 30px;width: 486.375px\">\n<ul>\n<li>Improvements in fluid\/sodium intake from diet history?<\/li>\n<li>Improvements in edema, weights, <button class=\"glossary-term\" aria-describedby=\"405-1648\">SOB<\/button>, <button class=\"glossary-term\" aria-describedby=\"405-1649\">IDWG<\/button> (if on dialysis)?<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\"><span class=\"ez-toc-section\" id=\"Evaluating_Raymonds_Nutrition_Care_Plan\"><\/span>Evaluating Raymond&#8217;s Nutrition Care Plan<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p>When assessing Raymond\u2019s status after the implementation of your nutrition care plan, you want to see if his phosphorus levels are WNL since he was previously hyperphosphatemic, so you request a repeat for serum phosphorus. You also decided to start a calcium based phosphate binder after liaising with the team, so you\u2019ll want to request a calcium level as well. Finally you\u2019ll want to check his fluid status by seeing if there have been any improvements in his edema.<\/p>\n<p>The results of the lab work you requested show that his serum phosphorus is 1.42 and is now WNL, but his calcium went up slightly to 2.55 as a result of starting the calcium-based phosphate binders. This means you\u2019ll have to keep an eye on his calcium and switch to a non-calcium based binder if it continues to rise. There has also been slight improvements in his ankle edema. As part of the plan you will continue the fluid restriction and low sodium diet and continue to monitor his fluid status and edema.<\/p>\n<p>Keep in mind that another part of evaluation that occurs in outpatient settings is following up with the patient regarding the SMART goals they set.<\/p>\n<table class=\"grid\">\n<tbody>\n<tr>\n<th style=\"width: 146.712px\" scope=\"col\">Common Nutrition Issues<\/th>\n<th style=\"width: 407.913px\" scope=\"col\">Evaluate effectiveness of NCP<\/th>\n<th style=\"width: 344.05px\" scope=\"col\">Outcome<\/th>\n<\/tr>\n<tr>\n<th style=\"width: 146.712px\" scope=\"row\">Malnutrition<\/th>\n<td style=\"width: 407.913px\">No concerns at this time<\/td>\n<td style=\"width: 344.05px\">&#8211;<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 146.712px\" scope=\"row\">Abnormal Electrolytes<\/th>\n<td style=\"width: 407.913px\">\n<ul>\n<li>Previously hyperphosphatemic, so ask for a repeat of serum phosphorus<\/li>\n<li>Taking calcium-based phosphate binder, so ask for repeat calcium<\/li>\n<\/ul>\n<\/td>\n<td style=\"width: 344.05px\">\n<ul>\n<li>Serum PO4 = 1.42 mmol\/L (WNL)\n<ul>\n<li>Normal range: <span>0.8 &#8211; 1.49 mmol\/L for CKD<\/span><\/li>\n<\/ul>\n<\/li>\n<li>Ca = 2.55 mmol\/L (up slightly from 2.4 mmol\/L on admission)\n<ul>\n<li>Normal range: 2.1 &#8211; 2.6 mmol\/L for CKD<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 146.712px\" scope=\"row\">Fluid Overload<\/th>\n<td style=\"width: 407.913px\">\n<ul>\n<li>Improvements in fluid\/sodium intake from diet history?<\/li>\n<li>Improvements in edema?<\/li>\n<\/ul>\n<\/td>\n<td style=\"width: 344.05px\">\n<ul>\n<li>Slight improvements<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n<div>\n<div>\n<h1><span class=\"ez-toc-section\" id=\"The_Nutrition_Care_Process_Model\"><\/span>The Nutrition Care Process Model<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<\/div>\n<div>\n<p>As you use the Nutrition Care Process Model and the learning from this case study as a guide throughout your patient care in practicum, please keep in mind that the process is dynamic, and not step-by-step as all cases are different. You are encouraged to complete the recommended readings for this module and continue to expand your learning in this clinical area of practice.<\/p>\n<\/div>\n<div class=\"textbox shaded\">\n<p>PART 4: EVALUATE COMPLETE. Pause to reflect on the evaluation strategies discussed, and review the readings and resources in the following section for your information.<\/p>\n<p>You\u2019ve now completed the Renal nutrition module. Please consider providing feedback through the embedded form in the next section.<\/p>\n<\/div>\n<h1><span class=\"ez-toc-section\" id=\"Acknowledgements\"><\/span>Acknowledgements<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<\/div>\n<p>Arti Sharma Parpia, RD, MSc<br \/>\nJess Wiles, RD, MHSc(c)<\/p>\n<p>&nbsp;<\/p>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"405-1648\" hidden><p>shortness of breath<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"405-1649\" hidden><p>inter-dialytic weight gain<\/p>\n<\/div><\/div>","protected":false},"author":89,"menu_order":4,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-405","chapter","type-chapter","status-publish","hentry"],"part":104,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters\/405","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/users\/89"}],"version-history":[{"count":33,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters\/405\/revisions"}],"predecessor-version":[{"id":2402,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters\/405\/revisions\/2402"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/parts\/104"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapters\/405\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/media?parent=405"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/pressbooks\/v2\/chapter-type?post=405"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/contributor?post=405"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/dietmods\/wp-json\/wp\/v2\/license?post=405"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}