Sandra Petrovets DIE 3213 Nutrition Therapy I Alireza Jahan-mihan September 17, 2013

Your name Sandra Petrovets CASE 1.

Date September 17, 2013

GENERAL NUTRITIONAL ASSESSMENT

1. Convert her height and weight to centimeters and kilograms. Calculate her % IBW, % UBW, and BMI. Interpret her weight and weight change based on these parameters. (5 points) Height: 170.18 cm1 Weight: 63.64 kg1 % IBW: 103.701 % UBW: 87.501 BMI: 21.971 The client is currently 140lbs and that is 103.70% of her ideal body weight. This means that she is at the weight that is ideal for her body, which is 135 13.5lbs. 140lbs is 87.50% of her usual body weight. This means that there was a loss of 12.5 % of weight from her usual weight. When she was 160lbs her BMI was higher, at 25, and that put her in the overweight status. Her BMI of 21.97 indicates that she is currently at normal status because it is between 18.5 and 24.9. 1 2. Calculate her nutritional requirements (calories, protein, and fluid) and compare her current intake to her needs. (5 points) Nutritional Requirements: Calories: BMR 1390 kcal1 Protein: 63.6g1 Fluid: 1906 mL2 Current Intake: Calories: 1029 kcal3 Protein: 71 g3 Fluid: 0.83 L2 The clients current calorie intake is 493 kcal lower than what is required. Her protein intake is 20g higher than the required amount and her fluid intake is 1.4 L lower than the required amount.

3. Are any major food groups and nutrients obviously missing from her diet? Explain your answer. (5 points) Yes. Dairy is a major food group that is missing from her diet. Without the dairy food group she is missing calcium that can be found in milk, cheese, yogurt, and other milk products.2 Also, she could be missing phosphorus which is found in cheese, egg yolk, milk.2 Other nutrients that might be low in her diet are magnesium (from milk) and sulfur (from eggs, milk, and cheese).2 The other food groups like grains, vegetables, and fruits do exist in her diet but the amounts that she is taking in is under the amount that she should be taking. 4. Do you think she could be experiencing any drugnutrient interactions? If so, what dietary suggestions would you make? (5 points) Yes. Because she has hypertension she is taking furosemide 20mg a day and that does have a nutrient interaction. Furosemide can eliminate water, sodium, and chloride from the body.1 It can also cause loss of potassium, calcium, and magnesium.1 I would suggest that she intake supplements of potassium, magnesium, and calcium because she prefers not to eat eggs and milk.1 She can increase her intake of seafood like oysters, salmon, clams, sardines, or try to eat kale, collard or mustard greens, white beans, navy beans, or tofu to increase her calcium.2 For magnesium, I would suggest whole-grain cereals, green vegetables, quinoa, buckwheat, and legumes.2 Also, I would suggest that she increase her water/fluids intake because of the drug-nutrient interaction and because she is not consuming enough fluids in her diet. 5. Interpret her serum albumin and prealbumin. In addition to nutritional intake, what factors can cause these indices to drop? What factors would cause them to be elevated? (5 points) Her serum albumin is slightly lower than the normal range of 3.5-5.5 g/dL at 3.2 g/dL.1 Her prealbumin is much lower than the normal range of 16-40 mg/dL at 11mg/dL.1 Albumin may elevate with dehydration.1 It will drop if there is poor protein intake, liver disease, or acute inflammatory disease.2 Prealbumin will drop low with inflammation, infection and with acute illness and it will elevate in kidney disease. 1 Also, zinc deficiency will decease prealbumin serum levels.2 6. Describe how factors in her anthropometric, biochemical, clinical, and dietary nutritional assessment data all fit together to form a picture of her nutritional health. (5 points) Looking at the picture of her nutritional health it is clear how certain factors influence each other. Because of her loss of her husband, she has been unmotivated to cook and was not getting enough calories. That was contributing to her weight loss and nutrient loss. Because of her diet preferences, she was not getting enough dairy nutrients that have caused her bones to weaken and fracture. When she fell and fractured her femur

this caused her prealbumin to drop because of the inflammation. Her albumin is almost at the normal range, which means that she is getting enough protein and not completely dehydrated. 7. Write a PES statement based on the nutritional assessment data available. (5 points) Inadequate oral food/beverage intake is related to oral intake that is less than the recommended and calculated amount as evidenced by a weight loss of 12.5% in 6 months. 8. What dietary and social changes would you suggest to improve her nutritional intake? (5 points) I would suggest that she increase her fluid intake, her dairy intake, and overall nutrition. Even though she has fruits and vegetables in her diet, they are very sparse. Because she is not taking in enough calories, she has room to include more vegetables that can give her calcium, magnesium, and potassium. For social changes, I would recommend that she spends more time with family and friends and cook with them. She feels unmotivated to cook and to eat because she is alone and most likely depressed. She needs someone to motivate her, help her develop self-efficacy, become independent and rebuilt her life from her loss. With the new motivation, she will start cooking again and eating more food that will give her the nutrients that she is missing from her diet. 9. What are your nutritional goals for her, and how would you monitor the effectiveness of your interventions from question #8? (5 points) My nutritional goals for her are to increase her nutrient intake and fluids. I would monitor the effectiveness of the interventions by measuring her weight to make sure that she is maintaining weight and not losing pounds. I would also like to see increased fluid intake from the 3.5 cups she is currently consuming. I would look for calcium rich foods in her diet either from dairy, seafood, or vegetables. In addition, I would like to normalize her blood parameters and suggest labs for K, Ca, Fe, B12, and monitor those. 10. Write a note documenting your assessment in SOAP format. (5 points) September 17, 2013 1:40pm Subjective: Client was admitted to the hospital for a femur fracture and was found to have a weight loss of 12.5% within 6 months because of motivation loss due to husbands death.1 Objective: Client is 76 years old with a history of hypertension, is 67 tall, and weighs 140 pounds. Her % IBW is 103.70, her % UBW is 87.50 and her BMI is 21.97. Her usual

weight is 160 lbs from 6 months ago. Her labs showed normal ranges for sodium at 140 mEq/L, potassium at 3.2 mEq/L, chloride at 103 mEq/L, carbon dioxide at 29 mEq/L, BUN at 19 mg/dL, creatinine at 1.0 mg/dL, glucose at 108 mg/dL, hemoglobin at 12.0 g/dL, hematocrit at 38.1%. Her albumin range was at 3.2 g/dL and her prealbumin at 11 mg/dL which is low. She is currently taking 20mg of furosemide daily and no supplements. Her current intake is 1029 calories, 71g of protein and 0.83 L of fluids daily. She does not smoke, drink alcohol, her husband died 6 months ago and the patient has lost weight since that time.1 Assessment: Inadequate oral food/beverage intake is related to oral intake that is less than the recommended and calculated amount as evidenced by a weight loss of 12.5% in 6 months. Her diet history shows that she is missing dairy nutrients and is not consuming enough vegetables, fruits, and fluids. Her calorie intake is lower than the recommended amount as is her fluids. She has had a significant weight loss but her BMI is in the normal range. Her labs came back all in the normal range except for her albumin which was slightly low at 3.2 g/dL and her prealbumin which was really low at 11 mg/dL; most likely due to inflammation of the fractured femur. 1 Plan: Client will increase intake of nutrients and fluids and maintain her body weight. Suggestions include more vegetables, or supplements, that can give her calcium, magnesium, and potassium.1 Good sources for these nutrients are: oysters, salmon, clams, sardines, kale, collard or mustard greens, white beans, navy beans, tofu, wholegrain cereals, green vegetables, quinoa, buckwheat, and legumes.2 Also, increased fluid intake is recommended because of the drug-nutrient interaction and because she is not consuming enough fluids in her diet.1 Lab values will also be taken and monitored. Sandra Petrovets

References
1. Emery EZ. Clinical Case Studies for the Nutrition Care Process. Burlington, MA: Jones & Bartlett Learning; 2012. 2. Mahan LK, Escott-Stump S, Raymond JL. Krauses Food and the Nutrition Care Process. St. Louis, MO: Elsevier Saunders; 2012. 3. Supertracker Website. www.supertracker.usda.gov . Accessed September 15, 2013.