Answer to Question 1
Mrs. Caldwell states that she has noticed her appetite has not been as good lately. She describes mild nausea but no vomiting. She relates that food has a bad taste. Most of these symptoms are most likely related to her increasing uremia. Symptoms should certainly improve as Mrs. Caldwell begins dialysis again and her BUN and creatinine levels diminish.
Answer to Question 2
Fluid requirements are recommended to be 1.0-1.5 mL/kcal of intake for adults. For Mr. Campbell's EER of 1800-2400 kcal/day, this would be 1800-2400 mL/day (1.0 mL/kcal) or 2700-3600 mL/day (1.5 mL/kcal). If he increases his protein intake he may need the higher amount of fluid to handle the higher renal solute load.
The intake/output record indicates his fluid requirement to be 2000-2500 mL (approx 1.0 mL/kcal). This is a good range to start with; intake can then be compared with output and adjusted as necessary. Using the patient's intake from 9/22-9/23, he took in 2520 mL that day but only had 1440 mL output. This can be expected due to his likely dehydrated state and should be monitored to match his output. Fluid intake may need to be decreased if this trend continues.
Documenting the health history is a crucial step in providing patient care
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