HALL, ASHLEY
DIE 3213
CASE STUDY #1
SEPTEMBER 17, 2013
DR. ALIREZA
JAHAN-MIHAN
Your name Ashley Hall Date September 17, 2013
Case Study #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)

Height = 67 inches = 170.18 centimeters
67 inches x 2.54 = 170.18 centimeters

Weight = 140 pounds = 63.50 kilograms
140 pounds / 2.2046 = 63.50 kilograms

% IBW = ( current weight / IBW ) X 100
IBW = 100 + 5(7) =135
% IBW = ( 140 pounds / 135 ) x 100
% IBW = 1.037 X 100 = 103.70

% UBW = ( current weight / usual weight ) x 100
% UBW = ( 140 pounds / 160 pounds ) x 100
% UBW = 0.875 x 100 = 87.5

BMI = weight in pounds / ( height in inches )2 x 703
BMI = 140 / ( 67 )2 x 703
BMI = 0.03119 x 703 = 21.93
2. Calculate her nutritional requirements (calories, protein, and fluid) and compare her
current intake to her needs. (5 points)
Nutrition requirements for a 76 year old female, 140 pounds, and 67 inches

Choose my plate: 1600-calorie diet and 5 ounces of protein daily

DRI values: 46 grams of protein and 2.7 Liters daily
3. Are any major food groups and nutrients obviously missing from her diet? Explain
your answer. (5 points)
This plan is a 1600 calorie food pattern.
(A 76 year old female, 5 feet 7 inches tall, 140 pounds, physically active less than 30
minutes a day.)
5 ounces
2 cups
1.5 cups
3 cups
5 ounces
Most noticeable groups that are missing from the patient diet are the Grains and
Dairy. The patient avoid milk because of food preferences so patient need more calcium
fortified foods, the only item the patient receives calcium is from the ½ cup of orange
juice during breakfast. The required amounts of grains are 5 ounces. The patient need
to make at least half of the grains whole grains.
4. Do you think she could be experiencing any drug–nutrient interactions? If so, what
dietary suggestions would you make? (5 points)
According to the patient’s lab results her values for potassium are 3.2 mEq/L and
the normal range for potassium is 3.5 – 5.0 mEq/L. The patient is prescribed
Furosemide 20 mg daily. Furosemide is a potassium depleting diuretic and may cause
hypokalemia in patients. Hypokalemia is a lower than normal amount of potassium in
the blood.
A dietary suggestion for the patient is to increase her intake of potassium rich
foods in her diet. Since the patient rarely eats or drinks between meals she can select
food sources that contain potassium such as a banana or strawberries; or something to
drink such as grapefruit or pineapple juice. These items won’t involve cooking for the
patient.
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)
According to the patient’s lab results, her albumin levels were 3.2 g / dL and the
normal ranges are 3.5-5.5 g / dL . The patient’s prealbumin levels were 11mg / dL
and the normal ranges are 16-40 mg / dL . The patient lost her husband six months ago
and lost 20 pounds within that time frame. Albumin levels decrease with aging ( she is
76 years old.) Albumin levels less than the normal range indicate stress and
inflammation than overall protein nutrition. Prealbumin levels are often lower in patients
that have undergone recent stress or trauma. The loss of the patient’s husband is the
stress she has occurred within the last six months.
Factors that would cause albumin levels to be increased are when patients are
dehydrated and when they are prescribed anabolic hormones and corticosteroids.
Factors that cause prealbumin levels to be increased are when patients have renal
disease and Hodgkin’s disease.
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)
From the lab results her potassium is low and looking at her normal diet she is
not getting enough of dairy products. The medication she is taking has a side effect of
potassium depleting in the body. Consuming more calcium problems can provide
benefits for bone health.
7. Write a PES statement based on the nutritional assessment data available. (5 points)
Low potassium levels related to potassium depleting diuretics as evidenced by
potassium levels 3.2 mEq/L.
8. What dietary and social changes would you suggest to improve her nutritional intake?
(5 points)
Dietary changes:
 Increase intake of high potassium foods.
 Choose healthy snacks to eat on between meals.
 Make at least half of the recommend amount of grains whole
grains.
 Since patient avoid milk and eggs, add foods high in calcium such
as dark green leafy vegetables.
Social changes:
 Be physically active for least 150 minutes each week.
9. What are your nutritional goals for her, and how would you monitor the effectiveness
of your interventions from question #8? (5 points)
The patient adds a potassium food source three times a week starting Monday.
The patient adds a calcium food source two times a week starting in three weeks. To
monitor the effectiveness of the goals is to meet with the patient once a week for the
first month to follow up on the potassium goals and see if we can increase the
potassium rich sources in the diet. Have new labs drawn to see where the patient
potassium levels stand compared to the normal ranges.
10. Write a note documenting your assessment in SOAP format. (5 points)
S: The patient has low potassium levels.
O: Patient levels are 3.2 mEq/L.
A: Patient is diagnosed with hypertension and is prescribed a potassium-depleting
diuretic.
P: See if the prescriber can change the prescribed medication or have the patient
increase potassium rich foods to get her potassium levels to at least normal range.
References
1. Emery E. Clinical Case Studies for the Nutrition Care Process. Jones and Bartlett
Learning;2012:157-160.
2. Daily Food Plans.
http://www.choosemyplate.gov/myplate/results.html?name=undefined&age=76&gender
=female&weight=140&heightfeet=5&heightinch=7&activity=sed&weightN=126&heightfe
etN=5&heightinchN=7&validweight=1&validheight=1&. USDA Choose my plate website.
Accessed September 12, 2013.
3. Daily Food Plans.
http://www.choosemyplate.gov/myplate/results.html?name=undefined&age=76&gender
=female&weight=140&heightfeet=5&heightinch=7&activity=sed&weightN=126&heightfe
etN=5&heightinchN=7&validweight=1&validheight=1&. USDA Choose my plate website.
Accessed September 12, 2013.
4. Mahan L., Escott-Stump S., Raymond J. Krause’s Food and the Nutrition Care
Process. Elsevier; 2012:198.