Okay, I'm a newer nurse working LTC/skilled rehab and in my short career I have already had this come up 3 times and each time I promised I was going to read more on this. Today is that day. 3 times I've had a different nurse ask me if I knew whether a snack was okay/or not okay for a dialysis or resident on a renal diet. I have a diabetic child and a celiac child so I do great with diabetic diets and am fairly good at reading nutrition labels, but I get a little frustrated with renal diets because honestly I'm just never sure how much I'm supposed be limiting of what. I got the idea that I'm looking at potassium, phosphorous, sodium, and protein, but not sure how much I should be restricting and what amounts I should be looking for snacks to be under. I do better with label reading because this means I'm not limited to choices on my snacks I can give them - I can just read the label and say hey this should be okay. I got that they should have no OJ, bananas, tomatoes, dark sodas, or prunes, raisins, nuts. I'm a little confused about milk? I'm also confused about protein. I found this great link here Renal Diet and that was very helpful, but left me confused a little on protein and milk. It looks like milk really is a no-go, but I don't see a lot of milk substitutes available at the facilities I go to. Maybe I should look harder to see if they are available. How much milk should people have on a renal diet because that came up recently as well. I think the resident returned the milk saying she wasn't supposed to have it, but reading up on this she sounds right. I'm also not sure about protein. Not thinking I should be giving snacks with protein outside of their meals, but unsure on that as well.
I would love to get a list of good snack ideas as well. The usual snacks I see available are rice crispy treats, cereal bars, animal cracker, rice puff type snacks, sometimes pretzels, yogurt, puddings. I need some good ideas on foods that they can eat. I have no problem waltzing myself down to the kitchen and looking through what I can find at night, but I'd like to have some options of snacks to give my residents when they ask for something to eat.
So to simplify my questions.
How much milk?
How do I know whether to give/not give protein for snacks?
Snack idea list?
Acceptable amounts in grams of potassium, phosphorous, and sodium when reading labels for snacks?
I spoke with the dietition at one of the clinics in my area and she said that pre dialysis pts need to restrict protein intake to about 0.8mg / kG to preserve their remaining renal function. However, once on dialysis they will need more protein and the restrictions no longer apply. She did stress that protein usually comes with calories which can be an issue. Along the same lines, please be sure to give phos binders 5-10 min before food or immediately after if ordered, they don't do any good if given long before or after. Calciphylaxis is a terrible disease Calciphylaxis - Mayo Clinic Hope that helps.
I spoke with the dietition at one of the clinics in my area and she said that pre dialysis pts need to restrict protein intake to about 0.8mg / kG to preserve their remaining renal function...
I spoke with the dietition at one of the clinics in my area and she said that pre dialysis pts need to restrict protein intake to about 0.8mg / kG to preserve their remaining renal function. However, once on dialysis they will need more protein and the restrictions no longer apply. She did stress that protein usually comes with calories which can be an issue. Along the same lines, please be sure to give phos binders 5-10 min before food or immediately after if ordered, they don't do any good if given long before or after. Calciphylaxis is a terrible disease Calciphylaxis - Mayo Clinic Hope that helps.
No phos binders are given on my shift so that's not an issue. Thank you so much for your time. I will make sure to see how much of my resident's meal was actually consumed and use that as a guide for snacks going forward as well. I feel a lot more comfortable with taking care of renal patients with more knowledge on it. I'm also going to look for some continuing education on caring for dialysis patients.
No phos binders are given on my shift so that's not an issue. Thank you so much for your time. I will make sure to see how much of my resident's meal was actually consumed and use that as a guide for snacks going forward as well. I feel a lot more comfortable with taking care of renal patients with more knowledge on it. I'm also going to look for some continuing education on caring for dialysis patients.
but they need to be given anytime someone eats. Phos content in processed foods is extremely high. Cookies, crackers etc all use Phosphates as preservatives.
but they need to be given anytime someone eats. Phos content in processed foods is extremely high. Cookies, crackers etc all use Phosphates as preservatives.
Yes! If binders are ordered for meals they should be given with all food. There may be a meal dose and a smaller snack dose. Not all renal pts will have binders ordered, but it's kinda rare not to.
Yes! If binders are ordered for meals they should be given with all food. There may be a meal dose and a smaller snack dose. Not all renal pts will have binders ordered, but it's kinda rare not to.
but they need to be given anytime someone eats. Phos content in processed foods is extremely high. Cookies, crackers etc all use Phosphates as preservatives.
Wow! Thanks I had no idea. Going to look into that further next time I work. You folks are a wealth of information!
AcuteHD
458 Posts
I spoke with the dietition at one of the clinics in my area and she said that pre dialysis pts need to restrict protein intake to about 0.8mg / kG to preserve their remaining renal function. However, once on dialysis they will need more protein and the restrictions no longer apply. She did stress that protein usually comes with calories which can be an issue. Along the same lines, please be sure to give phos binders 5-10 min before food or immediately after if ordered, they don't do any good if given long before or after. Calciphylaxis is a terrible disease Calciphylaxis - Mayo Clinic Hope that helps.