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x I

NCP

illF-

Recorder: Lauren Dohertv

f2
Diagnosis: Type

Date:09/18/2012

.
. o o o

Diabetes

Age, gender:2d

male ''

Molt ;t1ls

@
'1

Dietary intake: PO

intake t /

Symptoms: Frequent urination, excessive thkst, and excessive hunger AnthroPometricmeasurements

o o
Energy,

Ht/wt: s'1:0' I 177.8cm and 165#l74.8r';kg


gMl= 23.7 kg/m2 (normal)

,1.

proteinandfluidneeds'
Total energy= 2371 kcal Protein= 59.87-74.8491d

o o o

(i

"WrnV)

Fluid= 2619 mVd- 2993.5 ml/d

For energy, used Harris-Benedict formula to determine REE then multiplied by

r r
Labsfiests

activiW (1.3) For protein, used non-stress factor:

(1.0)

,./

For fluid needs, used 35 - 40 ml/kg/day

o o o o

Hgb = 14.7 g/dl, normal

Hct=MYo,normal
Serum albumin = 4.3 g,ldL, normal (3.5 -5.0 Glycosylated hemoglobin = 9.4%-hjghFasting blood gtucor" =

g/dl)

19189!,

trtgL

Nutrition Diagnosis

Limited adherence to nutrition related recommendations RIT consumption of a poor diet especially for a diabetic. Patient does not monitor U]66OItucose and does not
glucose = 180m9/dL and exercise oftery ,, AE4 excessive hunger and thirst; fasting blood

HbAlc =9-4i6 Nutrition lntervention

a-

1.) Meals and snacks a) Raise intake of nutrition dense foods instead of empty kcafhigh kcal foods such as French fries and hamburgers; replace chips and cake snacks wlth

other nutrient dense snack foods; stop skipping breakfast b) Example foods for meals and snacks: nuts, lean meats, low-fat dairy (skim milk, yogurt) vegetables, fruits, lower fat "baked" chips, fish, eggs, diet soda,
etc.
2.)

Nutition-related management a) Make appointment with Exercise Physiologist b) Make appointment with NmriTiTTuEEEi-

Datez@.lt8l2012

Recorder: Lauren Doherty

Goals

1l Dietary intake to meet >75% of estimated energy needs 2l Learn exercise habits from Exercise Physiologlst 3) Learn to count carbohydrates within l week to help maintain blood glucose

4)lffi,bbodgruco,"r.,"r-h*'t[h$[,J#91,?h4^g,f#k4fi
blood glucose 34times per/day

;t)

Monitorirg and

eva

luation

r o o r
/)

Follow-up phone call after 3 days or 1wk later Ask the patient to do 3day food record and blood glucose torel log and bring it to the clinic to reassess blood glucose level Follow up egaln within 2 wks forexercise progress
Consult MD if the patient's blood glucase remains high following initiating new diet and exercise plans

rlb frt

c c*terk

7,

-l
l

NCP

#5 Diet Lab

rclLs/2A12

Recorder: Lauren Doherty

Nutrition Assessment . Age, gender: 2Z,female . Dietary intake: PO intake . Symptoms: NIA . Anthropometric measurements: o HUwt= 5'4"1162.56 cm and 220# 199.79k9

ffa l-/

'

o o

BMI=37.8 kg/m2 (obese) IBW= 120# 154.43 kg, %lBW=l83% (obese)

Enersv'

proteilil:,ti::H3*
'.

4.46kcard

t/-/
with actuar heisht and weisht with active rirestyre

Protein=l2.S7gld
Fluid= 3991.6-5987.4 mUd

Basld

"Pi"i::lf#;::?'13#r,""essor'prosram
factors included.

. .
Energy
Kcal

For protein, used "Food Processor" program and non-stressed state. For fluid needs, used 40-60 mUkgld

Table 1: 24-hr Recall


CHO

(e) 105

Fiber (g) 39

Sat Fat {s) 10 28.64

Pro (g) 128

Vit A
(ue) 3650 s000
73

Vit

vit c
{me) 30 75 100

lron
(me) 69.86
18

Ca

(ue)

(mg) 805
1000

Sodium (me) 4465 2300 194.L3


High

Recall
DRI

1285

22.25
15

%DRI Eval.
I

2864.46 44.86

Normall weightloss

393.85 26.65 Low

40.10 97.25

Normal

34.9L Normal

72.57 176.38
High

Normal

148.33 Normal

257.65
High

80.5

Normal

Normal

Nutrition Diaqnosis I High sodium intake and obesity R/T Nl - 4.465m9 and previous high kcal diet AEB %DRl 194.13a/o sodium atter 24hr
recall and

BMI-

37.Bkglm2.

\-

Nutrition

lntervention

-/

1.

2"
GoaIs

Meals and snacks a. Lower sodium meals b. Salt substitute or other seasonings c. Replace pre-packed foods with raw d. Choose "reduced/low sodium" pre-packaged foods Nutrition-related medication management a. Continue exercise for t hour (+) most days of the week

_/

1. 2.

Decrease sodium intake Decrease BMI into normalrange

Monitorinq and Evaluation . Follow-up phone callwithin one week . Request 3-day food record to compensate for non-atypical days

r "

Reassess %DRl for sodium to see if it is within normal range <2300 Request a log of weight every 2-3 days

=--

ExPeriment: Cholesterol

Date:10/17lzAn

Recorder: Lauren

a a

Age,

gender:*lmate

Dohefi

Dietary intake: PO intake


Symptoms: No complaints

a
a

Anthropometric measurements o Ht/wt: 6'1{ / L85.42cm and 245# /1-L1.13kg o BMI= 32.3 kglm' (obese)

o rBW=
o
o o

18zr#

rtr.;;il,

Energy, protein and fluid

Total energy=

needs <I5E*)-29*r*l+kcal e-t tb. S;

;iBW= r33.rurrro

,oo"r", ,4r5w

qO'

551c1
-

Protein="67 76R8-83,,1519/d

?a.4i

Fluid=J5O3*3.i92;LJ3,5+rLld

For enersy, usea wi!t<i1ABW

f.: ?g E$-6#trA30-35kcal/kg
*.8 7 Y -fl|9

3Mq .A 5 ha^l /dql Qo .ssgr&1


L to determine

ld^Y

"a1:

REE

Labs/Tests

o o o
o o

Cholqsterol24o m&/dU(highl
Hgb: 15.2

g/dl(normal) Hct:43%(normal) . /

Blood Glucose : 93 mgldl(normal)


TG: 123 mg/dl(normal)

Nutrition Diagnosis

Overweight/obesity R/T high fat/kcal diet and no exercise pattern AEB BMt (32.3

kg/m') in obese range, TolBW (L33.L52Lo/o) also in obese range, and total cholesterol is high l24O mg/dL., Nutrition lntervention
1.) Meals and snacks
I

,----

a)
b)

oatdteal, cheerios, low fat dairy products, fruit, egg whites, bran muffins, whole wheat toast, etc.
Breakfast

Snacks

baked reduced fat chips, vegetables (broccoli/carrots) dipped in lightffat free ranch
Lunch

c)
d) a) b)
Goals

lean turkey or chicken sandwich on whole wheat bread from home,

salads with light dressing

Dinner

lean chicken breasts, cooked vegetables,. riceJight pasta dish, etc.

2.) Nutrition-related medication management


Referral to Exercise physiologist

Referralto Nutrition Educationist

Exper.ft vreet,ehoilEsterd

traG @,Er@Z

Reco+der: Lauren Doherty

st*rt new diet irnnredidelyfollowing appointment with Nutrition Educationist;


meet new kcals intake

l-2lb#wk until IBW or normal BMI is reached 3) lowerc@sBeml to <2fr]ragfdlwithi* 6 months 4\t Segia esercitiBigr@diateb.fiofu{ng appointnrent with Exercise Physiologist
2) Weight hss of

Monitoring and evaluation


O

FO&w-trypMe*f u* hterto
Ask the

inquire

ahut

new di,et and exercise plan

FtfuntF.fto

iFG

dayfood record after first week and b,ring it in to the clinic to

reassess
a.

Reassestffitolin

3 nronths to determine if within normal Enges.

Track BW ewry 2-3 days and bring into

dnicto

reassess after 2 weeks

Experiment: HDULDL

DatetL0lz,,lz0tz

Recorder: Lauren Doherty

a a a
a a

Age, gender:54, female


Diagnosis : recovery from bypass surgery

Dietary intake: PO intake Symptoms: No complaints

Anthropometric measurements o Htlwt: 5'q' / t62.56cm and L48* 167.1317kg BMr=25.4kslm'(stighttyabovenormat) IBW= 120# / 54.4311kg, %lBW= 123.3333% (slightly above normal) Energy, protein and fluid needs

o
o
o o o

Oie,VWBiUYff
,/

0V&9

A \ &' I -

Total

enerq:

L7L4.8727-212?.L757

kcauday

Protein= 83.9146

- 100.6975g/day ,/ -

Fluid= L714.87Y7-2L23.L757 mVday

r
I I

For edergy, used Mifflin St. Jeor with current BW X activity factor 1.3 with injury

factor of 1.05

1.3 for a range to determine REE/day

For protein, used: current BW X {1.25-1.5}e PR0/ke/day For fluid needs, used current BW X 1

mVkcafday

Labs/tests

o o o o o o o o o o

Cholesterol 240 me/dl (high) TG:250 mg,/dl{high}

Asr 76 UIL (hieh) ALT 31 U/L (normal)


LDH 322 U/L (high)

cPK 268 U/L (hieh)


HDL

34mgldl {low) Bilirubin (Tota[ 0.5m9/dl


156ms/dl (high)

Bilirubin (Direct) 0.1m9,/dL


LDL

Nutrition Piasnosis Undesirable food choices RII'lack of nutrition knowledge/unhealthy diet AEB lipid profile, high TG (250m9,/dL), HDL low (34mgldl), high cholesterol l240meldLl, high LDL (156mC/dL), 1209/dayfat intake vs. 659/day DRl, high %lBw (123.333%) Nutrition lnterventlon
1.) Meals and snacks

a)

oatmeal, cheerios, low fat dairy productt fruit, egg whites, bran muffins, whole wheat toast, etc.
Breakfast

bl
c)

Snacks

baked reduced fat chips, vegetables (broccoli/carrotsldipped in

light/fat free ranch, bran muffins Lunch - lean turkdy or chicken sandwich on whole wheat bread from home, salads with light dressing

Experiment: HDULDL

Date: 10/21 l20t.z

Recorder: Lauren Doherty

dl

Oinner

lean chicken breasts, cooked vegetables, rice, light pasta dish, etc.

2.) Nutrition-related medication management

a) Referral to Exercise Physiologist b) Referral to Nutrition Educationist

c)
Goals

Referralto cessation of smoking program

Start new diet immediately following appointment with Nutrition Educationist; meet neyu kcal intake

\ f .$U VV

2l Lower cholesterol to <200m9/dL


3) Fgma\cising
PhYsiologist

within 6 months within 2 weeks following appointment with Exercise


HDL

4l lmprove lipid profile (raise within 3-6 months

to >s0mg/dL and lower

LDL

to <130m9/dL)

s) Reduce arnount of cigarettes and quit withirr 1 month completely

Monitoring and evaluation


a
a

Follow-up phone calUvisit in hospital lwk to inquire about new diet and exercise plan Ask the patient to do 3-6 day food record after first week to reassess

a
a

34 months to determine if within normal Reguest a log of the patient's smoking; how many cigarettes each day et9
Reassess cholesterol, LDL, and HDL in

ranges.

Experiment: Calcium Lab

Date:1U06/2AL2

Recorder: Lauren Doherty

a o

Age, gender:67, Male Dietary intake: PO intake


Symptoms: No complaints

a a

Anthropometric measurements o Ht/wt: 5'8" I L72.72cm and L66* 175.2963kS o BMI= 25.2 kg/m'(overweight) o IBW= 154#/69.8532kg, %lBW= 1O7.7722L% (ovenryelght) Energy, protein and fluid needs

o o o

Total energy= L957.227 Lo3kcal/day


Protein= 60.23704- 75.290ildaV Fluid= L957.227t03mVddy

For energ'y, used

\rrison
ol1

r .
Labsfiests

1.3 with iniury factor

Benedict Formula with current BW X activity factor for non-injury to determine REE/day

For protein, used: current BW X (0.8-1)e PRO/kg/day


For fluid needs, used current BW X

I mVkca/day

o o o o o o o

Cholesterol 188 mg/dl (normal) TG:89 mg/dl(normal! Glucose 112m9,/dl (normal) Albumin 3.89/dL (normal) Serum Ca = 9.8m9/dL (normal) Urinary
Ca = 3@mgy'day (hieh)

Nutrition Diagnosis
Urinary Ca is high; imbalance of nutrients R/f hieh protein intake and no Ca intake AEB high urinary Ca (300m9/day) and the self-reported intake of 1509 protein/day vs- DRt based on IBW

of55.88255-69.8s32s/day
Nutrition lntervention
1.) Meals and snacks

pro/day

/ V

a)

orange juice, oatmeal, cheerios/nutrient dense cereals, fruit (papaya/oranges,) egg whites, bran muffins, whole wheat toast, etc. Breakfast

b) Snacks *egetables

(broccoli/boiled spinach), bran muffins, almonds, soybeans/edamame, celery, etc.


Lunch

c)
d)
a)

lowered intake and lean meats; turkey or chicken sandwich on whole wheat bread from home, salads urith light dressing and 3oz serving of
chicken on top

- lean chicken breasts, cooked vegetables (collard greens/kale,) rice, pasta light dish, fish/salmon, etc.
Dinner Referral to Nutrition Educationist for protein/ca interaction information

2.) Nutrition-related medication management

Experiment: Calcium tab

Date:1U06l2012

Recorder: Lauren Doherty

b) C,a supplementation
Goals

of Sfilmg/day

Start new diet irnmediatelyfollowing appointment with Nutrition Educationisg meet new DRI for gfitms protein/day

2l Meet fluid intake requirements 1860.2854mVday 3l Begin Ca supplementation and 4l Begin Ca rich foods intake immediately s) Lourer urinarya to flormalvalue {1@240rng/d} within 2-3 weeks
Monitoring and

evaluation
Follow-up phone call within
Ask the pataent to do

o
a a o

supplementation, and fluid intale

\rys to inquire about dietary changes for Ca intake, Ca

3{

day food record after first week to reassess ca intake

Request a log of fluid intake


Reassess urinary ca

within 2-3 weeks to see if within normal range (l0&2aomaldl

,P

\
Experiment: Triglyceride Date: 09/28

l20t2

Recorder: Lauren Doherty

Age, gender:37, female Dietary intake: PO intake


Symptoms: Complains of being'worn out;" fatigue/exhaustion

a a o

Anthropometric measurements

o o o o o

Ht/wt:5't"
BMt= 28.7

lL54.94cm and L52* 168.946k9

kg/m'(ovenrveight)

rBW= 105f /47.62r2ye,%rBW= t44.76L9% (ovenrueightl

/ llbtgrl

Energy, protein and fluid needs

Totalenergy= 1s18.117-177L.L36s kcal( protein= /m./$:,11&50.5c)899(d


Fluid= tStB.ttT-t771.13G5

l1q 5 1$e QtYtu


REE

r r r

ntld

/ a(|n y

\BW (50.60389kg) x 30-35kcal/kg to determine For protein, used: wilkins Alw (50.60389kg) (0.80-1.0olg PRo/kg For fluid needs, used Wilkins ABW {50.60389k9 1 mUkcaUday
For energ'y, used Wilkins

Labsflests

o o o o o

Serum albumin: = 4.2 gldl- normal (<3.8 Hgb: 13.4 g/dl (normal)

g/dl)

Hct:41% (normal)
Blood Glucose: 145 mg/dl(hiehl

TG:250

me/dl(high) '-

Nutrition Diagnosis

.-0.4

rST'{ yug AVe *e.Etz{ VV(9{, YWb YLIT


i

torng

wwpf,iovT

Adeqnateiroaintafte; high B%He tg_beine overweighf TG high and high fat diet and no exercise

andrG 2s0mglfllhishl
t

tBG:L!ffr;':x':Tq lu

ovenre,*n,@"'S; ifi

of 't W--frro dE +

tc-l

Nutrition lntervention
1.) Meals and snack

a) b)

Needs

to lower fat and carbohydrate intake; raise fiber and whole grain

intake. Replace high fat foods like chips, candy, and fast food. Example foods for meals and snacks: nuts, whole grain breads/pastas, fruits, vegetables,lean meats

etc.

,/

2.) Nutritien-refuted medication management

a) Z
Goals

1)

Start new diet immediately; meet new kcals intake


.

2l Weight loss of l-2!bs/wk until IBW or normal BMI is reached 3l LowerrGlevelswithin3-4months fU What ltvel ? N \VWLI 4l Lower carbohydrate intake/learn to count carbohydrates, lower BG
5)
Begin exercising immediatelyfollowing appointment with Exercise Physiologist

=ffi:ytEry;f+ ? ti:y'.3

iili:

-,'?smEFtIw;Effii{q:

Recordg: Lauren Doherty

-'p. Foll*up pttore EEEEE!, to inquire abo*rt mr det and exercise plan . \"-:-]1r. " &a Askth6.?a#erltto *yfoot*reeod kandbringitintotheclinicto
i

r Askfioia hgof ttre @r*ee*irEEEi#Ar/aay o MgcTGffiiE }4mrths to det=iffiifiEiftrfthin normal ranges. o Tractffif,!ry-S6h/s and brilEiffiSnk to re&ss after 2 urceks

raa$Bss

...-.'?

; {fr(*

lh

...
,l

Experiment: Blood albumin

Date:O9lL6l2OL2

Recorder: Lauren Doherty

o . o . o

Diagnosis: Bladder cancer

AB, gender:55, female Dietary intake: PO intake


Symptoms: Decreased appetite since chemo, N/V when tries to eat

Anthropometricmeasurements o Ht/wt: 5'5" I L65.Lcm and LLz# | 50.9k9 o e]/.l=Ls.7 W (normal) o IBW= 125# / 56.8k& %UBW= 89.6% (mild malnutrition) p UBW= t23*155.9k9, %UBW= 91% (mild malnutrition) loss: 8.9% (mild degree of malnutrition) "\3* Energy, pr.fein and fluid needs '

o o o

Total energY= 1998-2306 kcal Protein= 50.9-63.6 g/d


Fluid=

t782mlld
For energ'y, used Harris-Benedict formula to determine REE then multiplied by

r r o
Labsfiests

activity (1.3) & injury factor (1.3-1.5) For protein, used stress factor for tumor: {1.0-1.25 g PRO/kg
For fluid needs, used 35 mykg/day

o o

Totat PRO = s.s g/dLr serum albumin =

z.ffitow

tuj:6.0 ddL)
(<3.8

e/dl)

,./

Nutrition Diagnosis

lnadequate protein intake (or inadequate energy intake) R/t poor appetite and N/V caused by chemotherapy;!!fu90% lBW, 8.9% wt loss, low total protein and low serum

albumin.

Nutrition lntervention
1.) Meals and snacks

a) Supplemental protein drink TID between meals b) Examph fioods for meals and snacks: nuts, meats, dairy (cheese,) soy
2.)
products (tofu & soy beans,) fish, eggs, etc. Nutrition-related medication management

a)
Goals

REC

appetite

stimulant

U Dietary intake to meet >75% of estimated energy needs 2l Weightgain of 1#lwk until pt reaches ee""v" 'v' UBWIIBW 3) Protein need: 50.9-6 3.6 Etd '/

atbumin h..ySST

* week "?i;@iit ''tJ: ". r

r tullqrui*ii 'ffi r 3 dS or 1 n* later . Asksle-Ftt&httodokyfuod rcsd ard brirg ittothe clinicto reassess BW, protein
inta*e have increas(dfut*

ffiffa*,*lt
{ u*s to detennine if within
normal

/.

Se.assess

tod'proEtn

and serum albunrin in

ranges.

Consuh MD'f the petlent neeG a

hf;B-bofiuefiht

Ptslln case ttre patient still has hrr blood albumin

-ard

tr,

Anthropometric Lab
NCP

Lauren Doherty to / 3tl2ot2

Subject: Jeff Subject Age: 27 1. ldeal Body Weight (]BW)

weight: 184#,83.6k9 ) Height: ?tin, 180.3{m,-.,


Elbow Breadth: 2.913in, 7.tt00cm Frame Size: Medium

Life lnsurance Table Weight Range: 152-165#, 69-75k9

Hamwi BMlz L72(106# for the first 5 feet + 6# for each additional inch; 6 X 11 = 66 + rcA % IBW: t}6.g?%ll84lt72= 1.0697 X 100 = 106.97)

=*6

-/

Comment : The subject is within the ideal for %lBW in contrast to the Life lnsurance Table Weight Ralrge which shows that he is 19# overweight of the maximum weight in the range for his
2. Body Mass lndex (BMl)
BMI : 25.7kglmZ t83.6ke/1.8034m2 = 25.705)

height. ',/

Category: Overweight
3. Waist-to-Hip Ratio

Waist:85.09cm Hip:105.41cm
Wa ist-to-Hip Ratio: .807 ( desirable) {85.09/105.41 = .&O7 22891

Comment: Preferred ratio for men is <0.9; the subject falls within the preferred range.
4. Arm Circumference and Triceps Skinfold Comparison

_/

Trlceps:7mm,25s %ile Mid-arm Circumference: 342.9mm Arm Muscle Area:7200mm2, 75-90th %ih TotalArm Area: 9200mm2 Arm FatArea: 2000mmmm2, 50-75d'%ile {920G7200 = 20@)
5. Body Composition
A. Circumferences

Abdomen Constant 29
Buttocks Constant:42

Anthropometric Lab
NCP

Lauren Doherty

1A BL/?.OL2

Forearm Constant 34,5

Approximate body fat: 26.5% l4Z+29


B. Biochemical lmpedance Analysis Body fat: 28.S#, L5.7%(1S4
C. Three and Seven Site

34.5

10 = 29.S)

(BlA) X .157 = 28.8)

/
Mean

Skinf{ds
4.4mm
12.8mm
Sum: 30.7mm = X1

Three Site Skinfolds


Chest:

5mm 4mm 4mm 4.5mm

Abdomen:

12.5mm 14mm 14mm 13.5mm 13.5mm

Subscapular: 13mm 12mm 12mm 14.5mm (4.4+13.5+12.8=30.7)

Seven Site Skinfold

Mean 4.4mm

5mm 4mm 4mm 4.5mm

8mm 7.5mm 8mm 7mm 7.5mm 7.4mm Subscapular: 13mm 12mm 12mm 13.5mm 12.8mm Abdomen: 12.5mm 14mm 14mm 13.5mm 13.5mm
Suprailiac:

Midaxillary:

6mm 8mm 9mm 9mm

7.5mm 9mm 9mm 9mm

8.5mm 10.75mm

llmm lImm l1mm

10mm

(4.4 + 8 +7.4 +12.8 + 13.5 + 8.6 + 10.75 65.51 Sum: 65,5mm X3 = = Body density from 3 skinfold sites: 1.078 (1.1093800 - (0.0008267 x 3o.7) + 0.0000015 (30.7)? Body density farT skinfold sites: 1.078 t-trz- (0.00043499 x 6s.5) + 0.000o0055 (5s.sl2

0.0002574

(ltl * 1.s7s

-0.00028826x21= 1.078

Three Site Skinfold Sgdv Comoosition Results Bodyfat: 7.67k9,9.18% {83.6 X .0918 = 7.67;7.67183.6 X 100 = 9.18} Lean Body Mass: 75-93W,90.78yo (s3.6 - 7.Gt = 25.93; 75.93/83.6 x 100
Seve,n Site Skiqfold Bodv Cqmoogition Res,ults

= 90.78)

x .0918 = 7.67;7.67153.6 X 100 = 9.18) Lean Body Mass: 75.93 k9 90.78% {s3.6- t.6t = 7s.93; 7s.93/83.6 X 100 90.7s) =
D. Hydrostatic weighing {gold standard to estimate body fat} Residual Volume (RV) 1.49

Body fat: '1.67 k9,9.18% (83.6

Vqvtttrrrn? -,\
tJ
l
I

Anthropometric lab
NCP

Lauren

Dohefi LOl3t/}Otz
Ave:3.701(UWW) 3.70110.995671- 1.119 = 1.0615)
= 0.1952 X 100 = 19.52) 16.32 = 67,28;67.28183.6 = .8047 X 1@ = 80.478)

Trial 1. 3.807 2.3.568 3.3.629 Body Density: 1.0615 (83.6/ [83.5


Body tut: 16.32

kg 19.529( (495/1.0615 - 450 = 16.32; 16.32183.6

Lean Body Mass: 67.28kg,\Q.478% (83.5

Comment: Each body composition measurement yielded a different % body fat with the exception of the three skinfold and seven skin fold measurements which both yielded a 9.18% body fat whlch were also the lowest. Circumferences yielded 26.5%,BlA!5.7%, and the Hydrostatic weighing yielded 19.52%;
an average of all five %'s yields a 16.015% body fat which is very close to the 19.52% from Hydrostatic

{gold standard.} ln this case the skinfold measurements were likely the least accurate.

Mota fus G?4phol-J

I Experiment: Hemoglobin/Hematocr it

Date:09/21 r2o'2

-ecorder: Lauren Doherty

Age, gender: 22,

female

/ ,r/
ryprJ, n1 *o * V9lLtzr'a' n
8

a a o

Dietary intake: PO intake Symptoms: Complains of being "worn out;" fatigue/exhaustion

rn*

Anthropometric measurements o Ht/wt: 5'4" I L62.56cm and L08# /48.988kg o BM|=-19fJ--klmi (mito malnutrition) o IBW= 12O# l54.43LIkg, %lBW= 90% (mild malnutrition) Energy, protein and fluid needs

n,z [*flpl

nO.7

o o o

Total ener$y= 277 6.LO43-227 6.7O43 kcal Protein= 55.54488-66 .a31L g/d
Fluid= 2176.L043

r r r

mlld

For energy, used Mifflin-St. Jeor formula to determine REE then multiplied by

activity (1.3) & injury factor (1.0) +500kcals for lactation \.For protein, used: (0.80-1.00 g PRO/kg
For fluid needs, used L ml/kcal/day

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Labs/Tests

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Total PRo = 5.5 g/dl, low (<6.0 g/dl) serum atbumin =2.8eldL,y98 c/dr)

Nutrition

Diagnosis

ftW

lnadequate iron and energy intat<e d-geqib timited vegetarian diet, stopped taking vitamins and minerals prescribed by MD, and lactation AEB Hemoglobin = 9.5% (low)
and Hematocrit = 30% (low.)

Nutrition lntervention
1.) Meals and snacks

a) b)
2.)

Needs 95% or greater of energy needs and increase overall iron intake.
Example foods for meals and snacks: nuts, soy meats (tofu & veggie

burgers,)lentils, spinach, broccoli, etc. Nutrition-related medication management

a) Take supplemental daily vitamin/mineral


Goals

1) Dietary intake to meet >95% of estimated energy needs; start diet immediately 2) Begin taking vitamin and mineral supplements immediately / 3) Weight gain of 7#lwkuntil pt reaches IBW 4) lncrease overall iron intake from supplements and energy intake 5) lncrease Hemoglobin with iron rich plant foods 6) lncrease Hematocrit %
Monitoring and evaluation

Experiment'l'tertroglobin/Hematocrit DatetAgl2l/z0tz

Recoriler: Laure n Doherty

o r o

Follow*up phone call after 3 days or 1wk later Ask the patient to do 3-day food record after first week and.bring it in to the clinic to
reassess if BW and iron intake have increased ftonr previous visit
Re-aSsess HerSoglobin and Hematocrit in 90-100 days (4 months)

normalranges.

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to determine if within

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