1. CARLY LAURAINE KEENE STATE DIETETIC INTERN 2012-2013 SAMARITAN MEDICAL CENTER Final Case Study Presentation

2. Samaritan Medical Center 830 Washington Street, Watertown NY 13601 Picture retreived from: http://www.nyphysiciancareers.org/samaritan_medical_center.php

3. Samaritan Medical Center Our Services include:  Assisted Living Services  Behavioral Health  Cancer Services  Digestive Care  Emergency Department  Family Health Centers  Hospitalist Programs  Imaging/Radiology  Infectious Disease  Infusion  Laboratory Services  Long Term Care  Lung Care  Maternity  Neck and Back Program  Pain Management Center  Pediatrics  Rehabilitation Services  Robotic Surgery  Skilled Nursing Facility  Sleep Disorders Center  Surgical Care  Urgent Care  Urology Center  Women’s Health Services

4. Role of a Dietitian Clinical Nutrition Staff Mission Statement: Detect and assess nutrition problems Maintain nutritional status Instruct patients/residents in their diet before discharge Promote good nutrition

5. RD Policies Diet Manual:  Review Diet Manual Food and Drug Interactions:  Educate Guidelines for Assessment:  Braden Scale  NPO/Clear Liquids  As consulted by MD

6. Nutritional Priorities Priority 1  These patients are the highest risk for nutritional deficiencies, and will need to be reassessed within 5 days of initial assessment. Priority 2  These patients are at a moderate risk for nutritional deficiencies and will need a reassessment within 7 days of initial. Priority 3  These patients are at low nutritional risk and will need to be reassessed within 7 days.

8. Renal Disease Pathophysiology Normal Kidney Functions  Filtration  Absorption  Excretion  Secretion http://www.jeffersonhospital.org

9. Chronic Kidney Disease and Renal Failure “CKD is characterized by the inability of the kidney function to return to normal after acute kidney failure or progressive renal decline from disease.”  Nutrition and Diagnosis Related Care, Escott and Stump pg 864 Excess urea and nitrogenous wastes buildup in the blood stream, which is called azotemia.

10. 5 Stages of CKD StageGFRSymptoms 1>/= 90 mL/min/1.73 m 2 Kidney Damage with normal or inc GFR 260-89 mL/min/1.73 m 2 Kidney damage with mild decrease GFR 330-59 mL/min/1.73 m 2 Kidney damage with moderate damage and decrease GFR 415-29 mL/min/1.73 m 2 Advanced kidney damage and severe decrease in GFR 5/End Stage<15 mL/min/1.73 m 2 ESRD, kidney failure occurs