Hayley Kessler

FNES 365
Case 3- Malnutrition Associated with Chronic Disease
3. Current definitions of malnutrition use biochemical markers as a component of the diagnostic criteria.
Explain the effect of inflammation on visceral proteins and how that may impact the clinicians ability to
diagnose malnutrition. What laboratory values will confirm the presence of inflammation?
The clinician may be able to diagnose malnutrition in a patient due to the effects of visceral proteins such as the
decrease of negative acute-phase proteins like serum albumin, prealbumin, and transferrin. The decline of the
laboratory values listed above as well as an increase in C- reactive protein are an indication of inflammation.
4. What does the ADA evidence analysis indicate regarding the correlation of albumin/pre-albumin with
visceral protein status and risk of malnutrition during periods of prolonged protein-energy restriction?

The ADA evidence analysis indicates that during prolonged protein-energy restriction there is no
correlation between albumin/pre-albumin serum levels with visceral protein status for those that are at risk
of malnutrition.
6. Mr. Campbell was ordered a mechanical soft diet when he was admitted to the hospital. Describe the
modifications for this diet order.
Mr, Campbells diet was modified by allowing less than 5% of his food intake to be orally consumed as sips of liquid
which could be foods that are blended, grinded or mashed or already made drinks so that it can safely be swallowed.
To meet the rest of his liquid intake which was a total of 2000mL to 2500mL daily he received increments of liquid
through I.V.
7. What is Ensure Plus? Determine additional options for Mr. Campbell that would be appropriate for a highcalorie, high-protein beverage supplement.
Ensure Plus is a high calorie protein, vitamin and mineral ready to drink shake. It provides 350 calories with 13 grams
of proteins and 26 essential vitamins and minerals (Ensure Plus). It is used for patients who have malnutrition or are
at risk of malnutrition and may not be able to consume a regular diet.
8. Assess Mr. Campbells height and weight. Calculate his BMI and % usual body weight.
Mr. Campbells height was 63 and his weight was 156lbs. His BMI was 19.5 which is considered normal weight. To
calculate his % usual body weight, you use his usual body weight which was 220lbs and his actual body weight which
was 156lbs. His overall %UBW is 71% which places Mr. Campbell in the risk for severe malnutrition category.
9. After reading the physicians history and physical, identify any signs or symptoms that support the
diagnosis of malnutrition.
Signs and symptoms that support the diagnosis of malnutrition include feeling weak, unintentional weight loss,
cachectic, strength reduction, loss of muscle tone, decrease in lean mass in quadriceps and gastrocnemius.
10. Evaluate Mr. Campbells initial nursing assessment. What important factors noted in his nutrition
assessment may support the diagnosis of malnutrition?

The presence of soft, light brown stool, pale and tenting skin with ecchymosis and petechiae in Mr. Campbells
nutrition assessment may support the diagnosis of malnutrition.
12. Identify any signs or symptoms from the physicians history and physical and from the nursing
assessment that are consistent with dehydration.
Dry mucous membranes in the nose and throat and dry skin are signs that are consistent with dehydration.
13. Determine Mr. Campbells energy and protein requirements. Explain the rationale for the method you
used to calculate these requirements.
To determine Mr. Campbells energy requirements you can use the predictive rule of thumb of 25-30 kcal per kg per
day in order to form an estimate of his energy needs. With this formula Mr. Campbell would need about 1775-2130
calories per day. To determine his protein requirements you can use the formula of 1.2-2g per kg per day. Mr.
Campbells is malnourished and therefore should receive the higher amount of protein per day therefore putting his
protein requirements at 85-142g per day.
14. Determine Mr. Campbells fluid requirements. Compare this with the information on the intake and output
reports.
Using the formula 1mL per calorie per day and assuming his calorie needs was 1775 as previously calculated, Mr.
Campbells approximate fluid needs would be about 1775mL per day. His total intake was 2,520mL and his output
was 1,444mL for the day. His intake was above the fluid requirements possibly because he was considered to be
dehydrated. This led to a net of +1076mL of fluid intake.
15. From the nutrition history, assess Mr. Campbells usual dietary intake. How does this compare to the
requirements you calculated for him?
For the past several months his usual intake has been small amounts of whatever he consumes, with a few bites of
some things and sometimes drinking the entire can of ensure but not always. His intake seems like he is consuming
less than what is required for him which can lead to him being malnourished and losing weight.
16. identify the pertinent nutrition problems stating their corresponding nutrition diagnoses and write a PES
statement for two problems/diagnoses you identified.
Inadequate energy intake related to calorie intake not meeting required needs as evidenced by 60lb weight loss in 12 years.
Inadequate fluid intake related to fluid intake not meeting required needs as evidenced by elevated BUN and sodium.
17. Determine the appropriate intervention for each nutrition diagnosis.
For inadequate energy intake the appropriate intervention would be to consume a diet with increased protein and
calories.
For inadequate fluid intake the appropriate intervention would be to consume a diet with increased fluid so that he
can maintain a positive fluid balance.
18. Based on the criteria established in Jensen et al.s article as well as the consensus statement from AND
and ASPEN, what type of malnutrition is Mr. Campbell experiencing? Provide the specific criteria to support
your diagnosis.

Mr. Campbell seems to be experiencing chronic disease related malnutrition. He has lost a total of 60lbs over the last
two years which means it has been a chronic or ongoing issue rather than an acute form. In chronic inflammation the
acute phase actions are still under stress and therefore are not decreasing.
19. Identify the steps you would take to monitor Mr. Campbells nutritional status while he is hospitalized.
How would this differ if you were providing follow-up care through his physicians office?
While in the hospital you can closely monitor what Mr. Campbell is fed and what he eats and his daily fluid intakes.
Lab values can continually be taken to assess his improvement. This however is more of a short term monitor
because he would be constantly under care of the hospital. If he was being monitored through follow up care from his
physicians office it would be labs collected after a longer period of time with less direct care of the patient. They can
still monitor his overall weight loss of gain and if his physical condition appears to be any better. Lab reports can still
be taken to test if his nutrient levels are adequate.

References:
Ensure Plus (Retail). (n.d.). Retrieved November 9, 2015, from http://abbottnutrition.com/brands/products/ensure-plus-retail
Mahan, L. (2012). Krause's food & the nutrition care process (13th ed.). St. Louis, Mo.: Elsevier/Saunders.
Nelms, M., & Roth, S. (2014). Medical nutrition therapy: A case study approach (Fourth ed.). Belmont, California: Cengage.