Questions for Medical Nutrition Therapy: A Case Study Approach 5th ed.

Case Study C – Chronic Kidney Disease (CKD) Treated with Dialysis

(Case 19 in text)

Instructions: Answer the questions below. You may print your answers or e-mail them to your instructor.

1. Describe the basic physiological functions of the kidneys.

2. List the diseases/conditions that most commonly lead to chronic kidney disease (CKD)? Explain the role of diabetes in the development of  CKD.

3. Outline the stages of CKD, including the distinguishing signs and symptoms.

4. From your reading of Mrs. Joaquin’s history and physical, what signs and symptoms did she have that correlate with her chronic kidney disease?

5. What are the treatment options for Stage 5 CKD? Explain the differences between hemodialysis and peritoneal dialysis.

6. Explain the reasons for the following components of Mrs. Joaquin’s medical nutrition therapy:

 

Nutrition Therapy

Rationale

 

35   kcal/kg

 

1.2   g protein/kg

 

2   g K

 

1   g phosphorus

 

2   g Na

 

1000   mL fluid + urine output

7. Calculate and interpret Mrs. Joaquin’s BMI. How does edema affect your interpretation?

8. What is edema-free weight? Calculate Mrs. Joaquin’s edema-free weight.

9. What are the energy requirements for CKD?

10. Which of Mrs. Joaquin’s symptoms would you expect to begin to improve when she starts dialysis?

11. Calculate what Mrs. Joaquin’s energy needs will be once she begins hemodialysis.

12. What are the differences in protein requirements among stages 1 and 2 CKD, stage 3 and 4 CKD, hemodialysis, and peritoneal dialysis patients? What is the rationale for these differences?

13. Mrs. Joaquin has a PO4 restriction. Why? What foods have the highest levels of phosphorus?

14. Mrs. Joaquin tells you that one of her friends can drink only certain amounts of liquids and wants to know if that is the case for her. What foods are considered to be fluids? What fluid restriction is generally recommended for someone on hemodialysis? Is there a standard guideline for maximum fluid gain between dialysis visits? If a patient must follow a fluid restriction, what can be done to help reduce his or her thirst?

15. Why is it recommended for patients to have at least 50% of their protein from sources that have high biological value?

16. A. Based on Mrs. Joaquin’s energy needs, calculate her carbohydrate, protein, and fat needs, Using the Renal Exchange list, plan a 1-day diet that meets her energy needs and complies with her diet orders (see question 6)

B. Using Mrs. Joaquin’s typical intake and the prescribed diet, write a sample menu. Justify your changes; why did you make the change to comply with her nutrition prescription.

 

Diet PTA

Sample Menu

 

Breakfast: Cold cereal (¾ c unsweetened)

 

Bread (2 slices) or fried potatoes (1 med potato)

 

1 fried egg (occasionally)

 

Lunch: Bologna sandwich (2 slices white   bread, 2 slices bologna, mustard)

 

Potato chips (1 oz)

 

1 can Coke

 

Dinner: Chopped meat (3 oz beef)

 

Fried potatoes (1 ½ medium)

 

HS Snack: Crackers (6 saltines) and peanut butter (2   tbsp)

 

17. What resources and counseling techniques would you use to teach Mrs. Joaquin about her diet?

18. List the nutrition-related health problems that have been identified in the Pima Indians through epidemiological data. Are the Pima at higher risk for complications of diabetes? Explain. What is meant by the “thrifty gene” theory?

19. It is inevitable that there will be individuals who suffer from a disease that cannot be cured. How can you use God’s word in your work with these people? See 1 Thessalonians 3:1-3

Part B – Pre-Interview Task

Please complete the following task carefully as it is one of the factors we take into consideration when making a decision about your application. Please note that it is not only permissible but actively encouraged to refer to a grammar book and a dictionary in preparing your answers. Bear in mind that your explanations should reflect what you might say in a classroom to students and so should not be over-complicated.

 

 

Part One – Grammar

For each of the following sentences: 1. Correct the error, which is highlighted. Write the corrected sentence as done in the example.

2. Explain, as simply as possible, why the corrected version is more appropriate.            Example:

Incorrect sentence	I read a book at the moment.
Why is this incorrect?	Because the present simple does not refer to what you are doing at the moment of speaking but, for example, to habits. “I read a book every month” would be correct.
Corrected sentence	I’m reading a book at the moment.
Why is the sentence correct?	We use the present continuous to express the idea of an action taking place at or around the moment of speaking.

1.1

Incorrect sentence	I ’m going to the cinema at least once a week.
Why is this incorrect?
Corrected sentence
Why is the sentence correct?
1.2 Incorrect sentence I used to see that film for the first time two years ago. Why is this incorrect?   Corrected sentence   Why is the sentence correct?       1.3 A: Do you fancy playing tennis at 12 o’clock tomorrow? B: I’m sorry, I can’t join you at that time (and now choose from the following to complete the answer – please say which answers are possible and which are not. To give you a clue, two are incorrect for this context, one is preferable and the other two could be seen as possible; please explain your decisions):   Answers Correct or not and why I have lunch with Mary.   I’m having lunch with Mary.   I’m going to have lunch with Mary.   I will have lunch with Mary.   I’ll be having lunch with Mary.

 

 

Part Two – Grammar

How would you explain to a learner of English the difference in meaning between the following pairs / sets of sentences?

 

2.1 (to an intermediate level student):

1. If he comes with us, he’ll learn some Spanish. 2. If he came with us, he’d learn some Spanish. 3. If he’d come with us, he’d have learnt some Spanish.         2.2 (to an elementary level student):

1. She likes ice-cream. 2. She’d like an ice-cream.         2.3 (to an upper intermediate level student):

1. She went to prison. 2. She’s gone to prison. 3. She went to the prison. 4. She’s gone to the prison. 5. She’s in prison. 6. She’s at the prison.

 

 

 

Part Three – Vocabulary

How would you explain to a learner of English the difference in meaning between the following pairs / sets of words? 3.1 (to an intermediate level student):   1. Economy. 2. Economical. 3. Economics.         3.2 (to a pre-intermediate level student – and please indicate the part of speech for these items):   1. Embarrassed. 2. Introvert.
3.3 (to an elementary level student):   1. Smile. 2. Sneer.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part Four – Pronunciation

Divide the words below into four groups depending on the number of syllables and the syllable which is stressed.

 

 

recollect	recover	issue	tomorrow	frankly	exact
enrol	dungarees	allude	starting	starvation	unemployed

 

 

Group 1	Group 2	Group 3	Group 4

 

 

 

 

 

Part Five – Functional Language

 

A function is, put simply, what a piece of language does / expresses. For example, when you say “If I were you, I’d take an aspirin”, the function is that of giving advice. What are the functions of the following pieces of language?

 

 

Example piece of language	Function
“If I were you, I’d take an aspirin.”	Giving advice.
“I wish I hadn’t missed the train!”
“Can I go out and play?”
“Let’s have a drink!”
“I’m really sorry I broke your plate.”
“Would you like a piece of cake?”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part Six – Teacher Talk

Re-phrase the following examples of “teacher talk” in language that an elementary level learner might understand:     6.1 So, what we’re going to do now is open our books on page 47 please.         6.2

Could you possibly say what you just said again so that the others can hear?

6.3 If I were to ask you what the name of this tense is would any of you actually know?

 

 

 

Part Seven – Teaching Ideas

 

Imagine you are teaching a multilingual group (therefore no use of translation) of beginners studying English for the first time (they may have had a couple of lessons and can use language such as “Yes”, “No”, “Please” and “Thank you”). How will you try to convey the meaning of the phrase “Would you like…?” with the target sentence being “Would you like a cup of coffee?”

 

 

 

 

 

 

 

Part Eight – Skills

 

Language teaching is not just about grammar and vocabulary; we also teach language skills, these being speaking, writing, reading and listening. The following are the stages of an example reading lesson. Please put a number in the middle column to indicate the order in which you would do the stages and then in the right hand column, briefly explain the rationale for your choice.

 

 

Stage	Order	Rationale
Students check answers in pairs
Brief open class feedback
Students check answers in pairs
Open class feedback in which students may be asked to justify their answers
Pre-teach vocabulary
Students read with a short, strict time limit
Generate interest in the text
An oral response-to-the-text task where students discuss what they have read
Predict the content
The teacher sets several more questions which encourage reading for detailed understanding
The teacher sets a question which encourages reading for gist (general understanding)
The text is further exploited for some of the language which was in it
Students read with a time limit

 

 

 

 

Part Nine – Methodology

 

Describe briefly what you see as the teacher’s main role in the classroom. Should the language classroom be teacher-led or student-centred? To what extent would you encourage pair-work and group-work and why?

 

 

 

 

 

Part Ten – an Extended Piece of Writing

 

In this part we need to see an extended piece of writing so please answer in continuous prose (as in a semi-formal essay, the type of which you will need to write on the course). We request that you do not use any form of spell-check or grammar-check in writing this section.

The total word limit for the following is 150-300 words but please try to cover all of the prompt questions.

 

1. What, for you, are the most important qualities of a teacher?

2. Based on the above answer as well as on your work / study experience to date, the Pre-Interview Task and your knowledge and research of the CELTA, what do you expect to be your strengths and weaknesses on the course?

3. Why do you feel that doing the course at this time is the right choice for you?

4. What are your expectations of the course?

5. What are your plans for after the course, e.g., do you plan to return to the same job, do you want to travel, do you want to teach immediately and if so, where, etc.?