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Your name ___Zach Lebovic______ Date __9/15/13_____
CASE 1.(Worth up to 50 points)
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)
67inches=170.18CM
140lbs=63.50 KG
Current BMI=21.9 (Normal)
Usual BMI= 25.1 (overweight)
%UBW=(100 x 140)/160= 87.5%
%IBW=107.7%
2. Calculate her nutritional requirements (calories, protein, and fluid) and compare her
current intake to her needs.(5 points)
Calories required= 354-6.91 x (76) + 1.0 x (9.36 x 63.5) + (726 x 1.7)
= 1657 Kcal
Protein .8-1.0 g/kg of body weight = 51-63 grams of protein ( may need extra protein to help recover
from injury). Currently she is only consuming about 4oz a day or about 70% of her protein need.
Fluids= DRI for 70+ female= 2.7L/day
3. Are any major food groups and nutrients obviously missing from her diet? Explain your
answer.(5 points)
No dairy products-Able to tolerate but does not prefer taste.
Very few sources of grains or fiber.
Few sources of protein detected but more needed. (chicken thighs and peanut butter)
4. Do you think she could be experiencing any drug–nutrient interactions? If so, what dietary
suggestions would you make? (5 points)
Yes- Her furosemide (diuretic) explains why her blood potassium levels are low and why her overall
fluid state is dehydrated. (Confirmed by skin tugor test and dry oral mucosa.) I would suggest more
food sources of potassium or magnesium.
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)
Albumin accounts for 60% of total serum proteins and is responsible for transporting minerals,
proteins, enzymes and medications. It is also responsible for maintaining osmotic pressure. When
serum levels drop and promotes edema. Albumin has a half-life of 18-21 days so it is not indicative
of current protein status.
Prealbumin or transthyretin has a half life of 1/2 to 2 days, therefore it can be used as an indication of
protein status. Levels may drop do to metabolic stress or trauma, inflammation, and protein wasting
diseases.
Her albumin and prealbumin levels are both below normal. Some factors that may cause prealbumin
(PAB) to drop include insufficient protein intake and possibly a inadequate zinc intake. Another
factor that may have caused her prealbumin to drop is the result of physical and metabolic stress.
Inflammation could be a result of the recent femur fracture or the significant weight loss over the last
six months. Although her albumin levels are not elevated, factors that can increase prealbumin
include pregnancy and nephrotic syndromes.
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)
Her anthropometric results show that she has had significant undesired weight loss over the
last six months. According to her food intake history not many sources of protein were detected.
Only 2 tbsp of peanut butter and approximately 4oz of chicken a day are not likely to fulfill her
protein DRI of about 50 grams a day (.8g/IBW=49 grams of protein.) The low intake of protein and
calories over the last six months may have lead to some metabolic stress and inflammation. As well,
her recent femur fracture may have caused some additional inflammation. All of which can be
reasons for the lower than normal levels of albumin and prealbumin.
Some sources of zinc were detected in diet (spinach) making zinc deficiency less likely to be the
cause of the lowered prealbumin.
7. Write a PES statement based on the nutritional assessment data available.
(5 points)
Involuntary weight loss greater than desired, evidenced by weight loss greater than 10 % in 180 days.
8. What dietary and social changes would you suggest to improve her nutritional intake? (5
points)
1) Priority-Dentures need to be fitted and taken care of properly.
2) pertinent- More sources of protein. Perhaps milk substitutes such as soy. Eggs or egg substitutes.
also legumes, lentils or beans for protein and fiber.
3) Consume fluids throughout the day.
4) Beneficial- More grains and whole grains.
5) Important- Cannot eat every meal alone.
6) Seek professional counseling for loss of husband
9. What are your nutritional goals for her, and how would you monitor the effectiveness of
your interventions from question #8? (5 points)
Short term objectives- while in hospital consume adequate protein and nutrient dense foods. (peanut
butter and chicken thighs are good choices she currently consumes)
Reasoning- low amounts of protein and calories may be causing some metabolic stress and
inflammation. Adequate levels will help reach requirements and aid in healing from her recent
broken hip.
Short term objective- While in hospital patient will receive proper education on denture care.
Short term objective- While in hospital patient will receive education on food groups containing
protein and nutrients.
long term objectives- introduce new sources of protein such as soy or beans and legumes. Patient
will modify how many times a week (at least 3 meals a week) they eat with family or support group.
Start with one meal and work to improve.
Reasoning- eating with a person or group can evoke positive emotions which can benefit food
choices and overall health.
Goal 2-Check with doctor to see if hypertension medication is still needed.
Reasoning- Despite the significant weight loss in the last six months, her BMI is in a healthy range
and she is not far from an ideal body weight. Perhaps her blood pressure might be in the healthy
range to revaluate her hypertensive treatment.
Goal 2 continued-If medication is stopped, consume foods and fluids throughout the day.
Reasoning- She may not be eating or drinking between meals because her medication instructions
say to take furosemide without food.
Goal 3- Maintain ideal body weight by consuming adequate food and nutrient sources.
Monitoring and Evaluation
While in hospital recheck blood work during check up for adequate levels of albumin, prealbumin,
and electrolytes.
Follow up visit
Out of hospital- if patients goals and objectives are not met, which is unlikely given patient history,
reevaluate and give new objectives.
10. Write a note documenting your assessment in SOAP format. (5 points)
Patient Case study 1
Date: 9/15/13
SubjectiveReports of wt loss or appetite decrease
possible chewing difficulties
ObjectiveHt-67 inches
Wt-140lbs
%DBW-107.7%
UBW-160lbs
%UBW-87.5%
Pertinent lab values:
Albumin 3.2 g/dl
Prealbumin 11mg/dl
potassium 3.2mEq/L
Diet related meds: Furosemide
EER: 1657 Kcal/day
protein: 50g/day
AssessmentNutritional status assessed:
Low albumin and prealbumin related to insufficient intake of protein
Diet history: Few sources of protein detected.
PlanMore sources of protein
Fluids throughout the day
ReferralClinical psychologist
Follow up Prn
University of North Florida
Nutrition and dietetics student
References
1)
Mahan, Kathleen. Stump, Sylvia. Raymond, Janice. Krause's Food and the nutrition care
process 13th edition.St.Louis, Mo. Elsevier saunders. 2012.
2)
Pronsky, Zaneta. Crowe, Jeanne. Food and Medication interactions 17th edition. Birchuville,
PA. Food medcation interactions. 2012
3)
BMI calculator. Available at http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
assessed on 9/15/13