Download Malnutrition Associated with Chronic Disease

Caitlyn Beck
Case Study 3—Malnutrition Associated with Chronic Disease
1.) Some metabolic changes that result from starvation include: inadequate nutrient supply;
metabolic rate decreases to conserve energy; the brain will start using ketone bodies as fuel—
breakdown of muscles for amino acids to provide energy begins to occur; immune functions start to
go down because there isn’t enough energy. All of this can explain his weight loss because any food
he is taking in is going directly to fueling the body and its functions. This doesn’t provide the body
with enough nutrition for weight consistency.
3.) One’s visceral protein status is the amount of protein that is contained in the internal organs.
When these proteins become inflamed, they don’t function as well. One is put into a state of
catabolism, which is the breaking down of proteins. You would be able to look at the patient’s
protein stores to see if there’s any presence of inflammation, which is indicated by low levels. When
inflammation is present, albumin isn’t a good judge of malnutrition.
4.) The AND evidence analysis indicates there is no correlation of albumin/pre-albumin with
visceral protein status and risk of malnutrition during periods of prolonged protein-energy
restriction.
5.) Nutrient requirements are altered by the inflammatory milieu. It impacts nutrition by elevating
resting energy expenditure and nitrogen and thereby energy and protein requirements. Loss of
muscle mass and function may occur insidiously and in the chronic disease state occur over months
to years.
8.) Height: 6’3” Weight: 156 lbs
BMI=
156(703)
(75)(75)
= 19.5
Weight loss %= 156/220= 69.5%
severe weight loss
9.) When looking at the patients general signs, you can tell that he is malnourished. He complained
about feeling weak and not having energy to do anything. His muscle tone is decreased; his skin is
pale; his skin is tenting, has tears and is dry; his respiration is also shallow. A decreased
temperature is also a sign of malnutrition. Also, when looking at his diet, it is apparent that he isn’t
getting enough nutrients and he also says he gets fuller faster. Lastly, when looking at his lab
results, it shows that he is low in quite a few areas which lean towards malnutrition, including
hematology and protein levels.
10.) (see above)
11.) A Braden score is a score based on the condition of skin and indicates the risk of developing
pressure ulcers. Based on his score of 17, he has little or no risk, but there is still concern about
friction and shear.
16.) Malnutrition related to phychological causes as evidenced by muscle loss and loss of
subcutaneous fat.
Inadequate oral intake related to decreased ability to consume sufficient energy as evidenced by
diagnosis of squamous cell carcinoma of tongue.
Caitlyn Beck
ADDITIONAL QUESTIONS:
13.) RMR = (9.99 X 70.76) + (6.25 X 190.5) – (4.92 X 68) + 5 = 1567.955 kcals/day
This obviously isn’t very much but that is because of his malnutrition status. With that being
said, I added an activity factor of 1.15 which indicates severe weight loss. With that added in, the
total kcals needed is 1803.15 kcals/day
As far as protein needs go, I could use that daily energy needs calculation and figure out the
percentage of calories that will need to come from protein.
1803.15 x .20 = 360.63 calories from protein. 1 g of protein = 4 cal; 360.63/4= 90.16 g protein/day
15.) After looking at his typical dietary intake Mr. Campbell is nowhere near meeting his required
1803.15 kcals/day that was calculated for him.
17.) As far as intervening with the first diagnosis, the patient should go through nutrition education
or counseling to get past the psychological causes so that he can begin a better diet overall. With
the second diagnosis, the patient should go through a texture-modified diet in order to not have
pain when consuming food so that he can still get the recommended amount of nutrients.
19.) I would continue to take his vitals and see if he is gaining weight every day. I would also see
how he is following his texture-modified diet and if he is getting the right amount of nutrients he
needs. Along with that, I would continue to counsel him and see how he is feeling/doing with the
diet and see if any of the psychological aspects that were holding him back from eating before are
gone.