HUN 3403 LIFE CYCLE NUTRITION CASE STUDY 3
Case Study 3: Chronic Mastitis, based on p201 in Nutrition through the Life Cycle 5th ed.
Part 1: Same general instructions as with Case 1; answer the questions in text.
Part 2: Same general instructions as with Case 1; create two (2) ADIME case notes, one for
mother and one for baby. The ADIMES are separate as they would be in two different
medical records. All calculations go in Part 3.
Part 3: All calculations, growth grid, and nutrient analysis are documented and included as
Part 3.
Your role is as WIC Nutritionist. This is Barbara Ann’s 6wk postpartum recertification
appointment and baby Bethany’s initial certification. You have 15 minutes per certification
appointment or 30 minutes total for the two clients. She completes the WIC forms while
waiting in the waiting room. A WIC Clerk has measured and documented their
anthropometric data and Barbara Ann’s hemoglobin (Hgb).

Barbara Ann (mother)
o Assessment:
o Body composition: Ht 5’5” / weight history below. Evaluate her prenatal
weight gain (actual against recommended). What is her postpartum goal
weight and recommended rate of loss?
 Pre 145#
pregnanc
y
 39 wks /
 173#
delivery
 8 wks
 158#
ppm
o Nutrient requirements: Use your choice of tools to estimate TEE, range for
grams of carbohydrate, protein, and fat. Specify the equations you use and
show your math.
o Intake domain: Analyze reported intake for total kcal, grams of carbohydrate,
protein, and fat. Also evaluate the key vitamins and minerals needed for
lactation. Compare her actual intake against her needs. Note Barbara Ann is
lactose intolerant. She does well on Lactaid milk and aged cheese.
 B: WIC cereal (~1c)with Lactaid milk (~1/2c), 1 slice cheese grilled
on toast, ½ grapefruit (fruit in season).
 Sn: granola bar, 8 oz WIC Juicy Juice
1
HUN 3403 LIFE CYCLE NUTRITION CASE STUDY 3

L: Leftover cooked meat in a sandwich, some sort of vegetable – often
WIC purchased carrots. If hungry may make a second sandwich.
 SN: Cheese on crackers or half a sandwich
 D: last night was fried chicken, pole beans, black eyed peas and
coleslaw. Water to drink
 Sn: 8oz Lactaid milk before bed
o Clinical domain: No labs other than her Hgb 12.6. She reports she ran fevers
when she first had the mastitis but now it’s just painful. She’s thankful for the
help of the Lactation Consultant as she’d really like to continue breastfeeding
for the whole first year if possible.
o Behavioral – Environmental domain: Barbara Ann reports “all is good” at
home. She mentioned as an aside that she feels blessed that she doesn’t have
to work. She’s living at home with her mother, sister, her sister’s 4 year old,
and her boyfriend. There’s a note in the file that the sister’s 4 year old is also
on WIC.
o Nutrition diagnosis: give one or two P.E.S. statements using the correct NCP
terminology
o Nutrition Intervention: Clearly state your intervention goals (consider weight,
continuing support of lactation, any nutrient recommendations).
o Monitoring / Evaluation: WIC low risk appointments may once every three
months and you may not be the nutritionist performing the follow-up. List out
exactly what you want evaluate and the education to complete in the next visit.
Also note what information and follow-up recommendations you might make to
the Lactation Consultant or Breastfeeding Peer Counselor.


Bethany (Baby)
Assessment:
o Body composition: Plot on growth chart and note weight/age, length/age,
weight/length; evaluate growth trends. Variation is to be expected. With only two
data points your assessment will be limited.
 A
 Le
 We
ge
ngt
ight
h
 Bi
 21”
 7#1
rt
0z
h
 8
 22.
 10#
w
5”
k
2
HUN 3403 LIFE CYCLE NUTRITION CASE STUDY 3



o Nutrient Requirements: Estimate calorie and protein needs. Specify the equations
you use and show your math.
o Intake domain – mom reports breastfeeding about every three hours. The baby
may sleep for four hours at night; with 6-7 wet diapers and 3-4 soiled diapers. If
she goes to shop she leaves pumped breast milk for the baby.
o Clinical domain: no other data than the issues mom has had with mastitis
o Behavioral – Environmental domain as above
Nutrition Diagnosis: give one P.E.S. statements using the correct NCP terminology
Nutrition Intervention: Clearly state your intervention goals (consider what is needed to
support breastfeeding. What anticipatory guidance will she need in the next three
months?)
Monitoring / Evaluation: List out exactly what you want evaluate and the education to
complete in the next visit. Also note any recommendations you might make to the
Lactation Consultant or Breastfeeding Peer Counselor.
3