LESSON PLAN Title: Renal Diet Name: Heidi Washburn Target Audience: Renal Dialysis Patients Terminal Objective Client will be able to plan an appropriate renal dialysis diet for him/herself.

Terminal Concept Renal patients must follow certain diet restrictions including low protein, low potassium low sodium, and low water in order to prolong health. Domain

Cognitive Taxonomic Level Application

References Krause pg 927, http://www.kidney.org/atoz/content/potassium.cfm Preparation: Flip chart Pre-assessment Lab values: Potassium: 6.0mEq/L (we want 3.5-5.5 mEq/L) Gained 10 pounds of water weight. Time (if in class):

Introduction Welcome, it is good to see you again. Time:

Supporting Objectives Content Outline Time Learning Experiences

Client will make 2 specific goals to decrease her potassium intake. Client will make 1 specific goal to decrease her fluid retention.

What happens in your body when your lab values of potassium: weakness, numbness and tingling if your potassium is at a high level. If your potassium becomes too high, it can cause an irregular heartbeat or a heart attack. Pictures of foods with potassium with amounts including fruits, vegetables, substitute salts, etc. (2-3 g/day) How to leach high potassium vegetables and other helpful hints Water is important to the body. However, when the kidneys don’t function, the water retention can be a big problem. It gets stuck in the interstitial fluid. Sodium increases fluid retention.

4 min Ask: How have you changed your diet to decrease potassium? Ask: What things can you think of that would have caused your potassium levels to be too high? Ask: How can you adjust your diet so that you can meet the requirements for potassium? Ask: What do you remember about what we talked about water last time? Ask: How have these changes gone? Ask: How do you plan to decrease your fluid retention?

Client will be able to explain how sodium affects fluid retention.

Calculate how much fluid she can have. Pictures of water, milk, other fluids, salt shaker and fruits/vegetables. Hints on how to decrease fluid retention (including sodium).

Closure On a scale of 1 to 10, how important is it for you to decrease your potassium intake? How determined are you to do it? On a scale of 1 to 10, how important is it for you to decrease your fluid retention? How willing are you? Why ____ and not ___?

Dialysis Diet

Potassium

• Potassium keeps your heart beat regular and your muscles working right.

• Your kidneys keep potassium at just the right level so that these organs work well.

• If your blood potassium becomes too low, you will experience weakness, numbness and tingling.

• If your blood potassium becomes too high, you are at risk for irregular heart beats and heart attacks.

High potassium fruits • Apricot, raw (2 medium)

dried (5 halves)

• Avocado (¼ whole)

• Banana (½ whole)

• Cantaloupe

• Dates (5 whole)

• Dried fruits

• Figs, dried

• Grapefruit Juice

• Honeydew

• Kiwi (1 medium)

• Mango(1 medium)

• Nectarine(1 medium)

• Orange(1 medium)

• Orange Juice

• Papaya (½ whole)

• Pomegranate (1 whole)

• Pomegranate Juice

• Prunes

• Prune Juice

• Raisins

Low potassium fruits • Apple (1 medium)

• Apple Juice

• Applesauce

• Apricots, canned in juice

• Blackberries

• Blueberries

• Cherries

• Cranberries

• Fruit Cocktail

• Grapes

• Grape Juice

• Grapefruit (½)

• Mandarin Oranges

• Peaches, fresh (1 small) canned (½ cup)

• Pears, fresh (1 small) canned (½ cup)

• Pineapple

• Pineapple Juice

• Plums (1 whole)

• Raspberries

• Strawberries

• Tangerine (1 whole)

• Watermelon (limit to 1 cup)

High potassium vegetables • Acorn Squash • Artichoke • Bamboo Shoots • Baked Beans • Butternut Squash • Refried Beans • Beets, fresh then boiled • Black Beans • Broccoli, cooked • Brussels Sprouts • Chinese Cabbage • Carrots, raw • Dried Beans and Peas • Greens, except Kale

• Hubbard Squash • Kohlrabi • Lentils • Legumes • Mushrooms, canned • Okra • Parsnips • Potatoes, white and sweet • Pumpkin • Rutabagas • Spinach, cooked • Tomatoes/Tomato products • Vegetable Juices

Low potassium vegetables • Alfalfa sprouts

• Asparagus (6 spears)

• Beans, green or wax

• Cabbage, green and red

• Carrots, cooked

• Cauliflower

• Celery (1 stalk)

• Corn, fresh (½ ear) frozen (½ cup)

• Cucumber

• Eggplant

• Kale

• Lettuce

• Mixed Vegetables

• Mushrooms, fresh

• Onions

• Parsley

• Peas, green

• Peppers

• Radish

• Rhubarb

• Water Chestnuts, canned

• Watercress

• Yellow Squash

• Zucchini Squash

Other Foods High potassium • Bran/Bran products • Chocolate (1.5-2 ounces) • Granola • Milk, all types (1 cup) • Molasses (1 Tablespoon) • Nutritional Supplements:

Use only under the direction of your doctor or dietitian.

• Nuts and Seeds (1 ounce) • Peanut Butter (2 tbs.) • Salt Substitutes/Lite Salt • Salt Free Broth • Yogurt

Low potassium • Rice • Noodles • Pasta • Bread and bread products:

(Not Whole Grains) • Cake: angel, yellow • Coffee: limit to 8 ounces • Pies without chocolate or

high potassium fruit • Cookies without nuts or

chocolate • Tea: limit to 16 ounces

How to decrease potassium For Potatoes, Sweet Potatoes, Carrots, Beets, and Rutabagas: 1. Peel and place the vegetable in cold water so they won’t darken. 2. Slice vegetable 1/8 inch thick. 3. Rinse in warm water for a few seconds. 4. Soak for a minimum of two hours in warm water. Use ten times the amount of water to

the amount of vegetables. If soaking longer, change the water every four hours. 5. Rinse under warm water again for a few seconds. 6. Cook vegetable with five times the amount of water to the amount of vegetable. For Squash, Mushrooms, Cauliflower, and Frozen Greens: 1.Allow frozen vegetable to thaw to room temperature and drain. 2. Rinse fresh or frozen vegetables in warm water for a few seconds. 3. Soak for a minimum of two hours in warm water. Use ten times the amount of water to

the amount of vegetables. If soaking longer, change the water every four hours. 4. Rinse under warm water again for a few seconds. 5. Cook the usual way, but with five times the amount of water to the amount of vegetable.

Water

• Water is essential to body functions. • However, without kidneys, your body cannot get rid

of extra water. • For dialysis patients, the goal is to have: 1500 mL of water + output each day • Drinks, soups, high water fruits/vegetables need to

be counted as well.

1500 mL = 6.34 cups

Sodium’s effect on body fluids

• Sodium causes the body to retain water. This causes your blood pressure to rise. It also makes you uncomfortable.

• To keep your water weight gain down, you may need to limit your sodium intake to 2-3 g/day.

• To give food taste, try other spices such as basil, curry, dill, ginger, thyme, sage, or rosemary.