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NURP 113 THERAPEUTIC NUTRITION
SPECIAL WRITTEN ASSIGNMENTS
CASE STUDIES
Assignment:
Review each case study assigned. Perform research as needed to answer the questions
accompanying each case study. Answers must be typed. Neatness counts! Each individual case
study is worth 40 points. Turn in on the due date assigned. Use complete sentences. Each Case
Study should be a MINIMUM of one type-written page.
HAND-IN AS AN ATTACHMENT TO AN E-MAIL TO PHOLLOWAY@CSI.EDU.
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THERAPEUTIC NUTRITION
CASE STUDY #1
Sudah P. is a 22-year-old recent college graduate who began her first professional job in a
marketing firm one month ago. As a college student, she occasionally experienced abdominal
pain and cramping after eating. She also experienced frequent bouts of diarrhea and noticed that
she felt better for a while after a bowel movement. Once Sudah began her new job, she noticed
that her symptoms were occurring more frequently. At first she attributed her symptoms to the
stress related to her new job, but when the symptoms continued for several months, she decided
to see her physician. Sudah is 5 feet 3 inches tall and weighs 118 pounds. After taking a careful
history and conducting several tests to rule out other bowel disorders, the physician diagnosed
irritable bowel syndrome. The physician prescribed bulk-forming agents and advised Sudah to
keep a food intake and symptoms record for one week. Sudah was then referred to a
nurse/dietitian to review the records and recommend appropriate dietary suggestions. In
reviewing Sudah's food intake records, it was noticed that Sudah eats many traditional Indian
foods, which are highly seasoned and often contain legumes. Sudah says that she began to drink
coffee and caffeinated cola drinks in college so that she could study for longer periods of time.
She has continued to drink coffee since that time.
1) How would you explain irritable bowel syndrome to Sudah? Be specific. Use language that
will be easy to understand.
2) What role does stress play in irritable bowel syndrome? Be specific.
3) Can Sudah's diet be responsible for causing irritable bowel syndrome? Why or why not?
Can any of these foods or food components aggravate her symptoms?
4) What type of diet benefits people with irritable bowel syndrome? Be specific.
5) What problem(s) can this diet cause?
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THERAPEUTIC NUTRITION
CASE STUDY #2
Charles Carter is a successful young businessman who works long hours and carries the major
responsibility of his struggling small business. At his last physical checkup, the physician
cautioned him about his pace because he was already showing some mild hypertension. His
blood cholesterol was elevated, and he was overweight. In his desk job he got little exercise and
found himself smoking more and eating irregularly under the stress of his increasing financial
pressures. One day while commuting in the heavy freeway traffic, he felt a pain in his chest and
became increasingly apprehensive. When he arrived home, the pain persisted and increased. He
broke out into a cold sweat and felt nauseated. When he became more ill after trying to eat
dinner, his wife called their physician and Mr. Carter was admitted to the hospital. After
emergency care and tests, the doctor placed Mr. Carter in the coronary care unit at the hospital.
His test results showed elevate total cholesterol, triglycerides, and lipoproteins, especially LDL,
but low HDL. The electrocardiogram revealed an infarction of the posterior myocardium wall.
When Mr. Carter was first able to take oral nourishment, he had only a liquid diet. As his
condition stabilized, his diet was increased to 800 kcal (soft diet) with low cholesterol and low
fat. By the end of the first week, his diet was increased again to 1200 kcal (full diet) with low
cholesterol and only 25% of the total kcalories from fat and a polyunsaturated/saturated ratio of
1:1. Mr. Carter gradually improved over the next few days and was able to go home. The
physician, nurse, and dietitian discussed with Mr. Carter and his wife the need for care at home
during a period of convalescence. They explained that he had an underlying lipid disorder and
was to continue his weight loss and follow a TLC (Therapeutic Lifestyle Changes) diet.
1) Identify factors in Mr. Carter's personal and medical history that place him at high risk for
coronary heart disease. Give reasons why each factor contributes to heart disease.
2) Identify as many of the laboratory tests the physician ordered as you can. Relate these tests to
Mr. Carter's condition.
3) Why did Mr. Carter receive only a liquid diet at first? What is the reason for each
modification in his first diet of solid food?
4) What occurs in the underlying disease process that causes a heart attack? What relation do fat
and cholesterol have to this underlying process?
5) What needs might Mr. Carter have when he goes home? How would you help him prepare to
go home? Name some community resources you might use to help him understand his illness
and plan self-care.
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THERAPEUTIC NUTRITION
CASE STUDY #3
Richard Smith, age 21, has type 1 diabetes mellitus. He gives himself two injections a day, each
a combination of medium-acting insulin and regular short-acting insulin. He does one injection
before breakfast and one before dinner and usually tests his blood glucose level before each meal
and at bedtime. Richard is a college student, who is usually active in athletics. However, this is
final exam week and Richard's schedule is irregular. He is putting in long hours of study and is
under considerable stress. On the day before a particularly difficult examination, he is reviewing
his study materials at home and forgets to do his blood test or eat lunch. About mid-afternoon,
he begins to feel faint and realizes that his blood glucose is low and an insulin reaction is
imminent if he does not get a quick source of energy. He looks in the kitchen, and all he can find
is orange juice, milk, butter, a loaf of bread, and a jar of peanut butter.
1) Which of the four foods should Richard eat immediately? Why?
2) Later, when he is feeling better, Richard makes a peanut butter and butter sandwich, pours a
glass of milk, and eats his snack while he continues studying. What carbohydrate food sources
of energy are in his snack?
3) Are these carbohydrates sources in a form that the cells can burn for energy? What changes
must Richard's body make in these sources to get them into the basic carbohydrate fuel form?
What is the complex form of carbohydrate in his snack? Why is this a valuable form of
carbohydrate in his diet? What is the basic form of carbohydrate fuel circulating in the blood for
use by the cells?
4) What is the relationship of carbohydrate and fat in the final production of energy in the body?
If Richard did not take his insulin to provide the necessary control agent for metabolizing the
carbohydrate, what would happen to him as the result of improper handling of fat and
accumulation of ketones? Be specific.
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THERAPEUTIC NUTRITION
CASE STUDY #4
Charles Brown, age 49, is an active man working at a large company who has begun to tire more
easily. He has little appetite and feels generally ill most of the time. He recently noticed some
ankle swelling and some blood in his urine. At his wife's insistence, he finally decided to see his
physician. After a complete work-up, his physician's findings included the following:
1. No prior illness except a case of the flu with a throat infection during Charles' overseas
service in the Army.
2. Laboratory tests: albumin, red and white cells in the urine; abnormal blood urea nitrogen and
glomerular filtration rate.
3. Other symptoms: hypertension, edema, headache, occasional vision blurring, and low-grade
fever.
The physician discussed the findings and the serious prognosis of advanced renal disease with
Charles and his wife, and together they explored the immediate medical and nutritional needs for
treatment. They also discussed the ultimate need for medical management with dialysis. The
physician prescribed medications to control Charles' growing symptoms and discomfort. As
time went by, Charles' symptoms increased. He lost more weight, was anemic, and experienced
increased bone and joint pain. Gastrointestinal bleeding and nausea also increased, and he had
occasional muscle twitches or spasms. Small mouth ulcers made eating a painful effort. Charles
and his wife made visits to the clinic dietitian to learn how to manage his present pre-dialysis
diet at home.
1) What metabolic imbalances in chronic renal failure do you think accounted for the symptoms
Charles was having?
2) What are the objectives of treatment in chronic renal failure?
3) What are the basic principles of Charles' predialysis diet? Describe this type of diet. What
foods would be included?
4) What nutrient-related medications and supplements would Charles' physician probably use in
his treatment plan? Why?
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THERAPEUTIC NUTRITION
CASE STUDY #5
After long experience with persistent peptic ulcer disease involving more and more gastric tissue,
John and his physician decided that surgery was needed. John then entered the hospital for a
total gastrectomy. John withstood the surgery well and received some initial nutritional support
from an elemental formula fed through a tube the surgeon had placed into his jejunum. After a
few days, the tube was removed and, over the next 2-week period, John was gradually able to
take a soft diet in small oral feedings. He soon recovered enough to go home and gradually felt
his strength returning. He was relieved to be free of his former ulcer pain and began to resume
more and more of his usual activities, eating a regular diet of increasing volume and variety of
foods. However, as time went by John began having more discomfort after meals. He felt a
cramping sensation and increased heartbeat, and then a wave of weakness with sweating and
dizziness. John would often become nauseated and vomit. As his anxiety increased, he began to
eat less and less and his weight began to drop. He was soon in a state of general malnutrition.
John finally returned to seek medical help. The physician and clinical dietitian outlined a change
in his eating habits, and a special food plan was worked out for him. Although the diet seemed
strange to him, John followed it faithfully because he had felt so ill. To his surprise, he soon
found that his previous symptoms after eating had almost completely disappeared. Because he
felt so much better on the new diet plan, he formed new eating habits around it. His weight
gradually returned to normal, and his state of nutrition improved. John found that he would
always fare better if he would "nibble" on food items throughout the day rather than consume
large meals as he used to do.
1) What were John's nutritional needs immediately after surgery and over the next 2 weeks?
Why was it necessary for his feedings to be resumed cautiously?
2) Why is emphasis given to post surgical protein sources? How should this nutrient be
provided?
3) Why is fluid therapy paramount after surgery?
4) What minerals and vitamins need special attention after surgery? Why?
5) When John began to feel better and resumed regular eating, why did he become ill? Describe
his symptoms and why they developed.
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THERAPEUTIC NUTRITION
CASE STUDY #6
Mr. J., a 48-year-old history professor, has a blood lipid profile that includes elevated LDL
cholesterol. He is 5 feet 7 inches tall and weighs 200 pounds. Mr. J. has a family history of
CHD. His diet history shows excessive intakes of food energy, cholesterol, total fat, saturated
fat, and salt. He smokes a pack of cigarettes a day, and his lifestyle leaves him little time for
physical activity. Mr. J. also has hypertension, for which antihypertensive agents have been
prescribed. He frequently forgets to take his pills, though, and his blood pressure is often quite
high.
1) Name the risk factors for CHD in Mr. J's history. Which of them can be controlled? Which
can be helped by diet?
2) What type of diet would you recommend to treat his high LDL cholesterol and hypertension?
Explain the reasons for each change.
3) What laboratory and clinical tests would you expect to see monitored regularly?
4) Name at least three ways in which Mr. J. could benefit from losing weight. How could he
benefit from a regular physical activity program?
5) What immediate nutrition considerations would need to be made if Mr. J. should suffer a
heart attack or stroke?