SAMPLE QUESTIONS
WRITTEN CASE STUDIES EXAMINATION
Sample Clinical Nutrition Case Study
George T is a 42 year old man with severe chronic obstructive pulmonary disease. He has
been referred to the Respiratory Clinic for a nutrition assessment in view of lung
transplantation.
George receives sickness benefits, lives alone and is often anxious and depressed. His health
affects his day to day functions and he is very limited in what he is able to do. He attends
physiotherapy at the hospital twice a week for rehabilitation. He has never seen a dietitian
before.
Weight history:
Height: 183cm
Current Weight: 61kg
BMI 18
Usual weight: 77kg
Weight loss has occurred gradually over the last 6 years. George has had 5 hospital
admissions this year. To receive a lung transplant, George must reach a goal weight of 67 kg.
Diet history:
Breakfast:
Lunch:
Dinner:
Snacks:
1x Weetbix, milk, sugar
Soup, occasionally yogurt
Small meal of meat, potato and vegetables, (sometimes too
tired to eat)
Rarely
Questions
1. Provide a summary nutrition assessment for George, noting any assumptions made.
2. Identify and justify the optimal clinical goals and objectives of dietary management for
George in order of priority. Include quantifiable goals.
3. Outline a client-focused approach for implementing these goals, including your suggested
changes.
4. Prepare a plan to evaluate the effectiveness of your intervention.
Clinical Case Sample Answer
1. Provide a summary nutrition assessment for this client, noting any assumptions
made.
BMI places George in the underweight category. His usual BMI is 23 so the weight loss
is significant. He has lost greater than 10% of his body weight indicating malnutrition is
likely.
No biochemistry results provided.
Clinically he reports insufficient energy to be able to do ADL’s (Activities of daily
living). Tiredness suggests the possibility of anaemia.
Dietary intake compared to core food groups:
About 1 serve cereal (should be at least 4).
No fruit
2 vegetable serves (should be 4-5)
Meat/ alternatives – may be sufficient but not for weight gain
Dairy/ alternatives – inadequate
Inadequate protein, energy and nutrient intake
His psychosocial history suggests support will be important/ what support does George
have?.
2. Identify and justify the optimal clinical goals and objectives of dietary management
for George in order of priority.
Answer should include quantities for all of these ( eg how much weight gain)
Adequate nutrients and energy to meet requirements (include calculation/reference to
protein and energy requirements for weight gain); (consider if patient may have fluid or
sodium restrictions)
Acceptable food that client can manage
Gradual weight gain (indicate rate of weight gain and link to energy requirements)
Continual follow-up and goal setting
Consider social/psychological assistance from other team members
3. Outline a client-focused approach for implementing these goals, including your
suggested meal plan.
Consult with client re food preferences and high energy and protein requirements at the
moment explaining that usual dietary restrictions or practices may need to be altered
(however, must consider if patient may have fluid or sodium restrictions important for
health and well being)
Discuss options with client, family/ client support group for high protein and energy
supplements in a variety of forms and possible sources eg hospital supply, family bring in
Arrange with appropriate personnel (hospital staff) for supplements to be provided and
monitoring of intake to occur
Clarify any concerns of client/ family/ support group
Sample meal plan should show small frequent meals/ snacks spread over the day using
variety of high protein, high energy products/ dishes, including easy and cheap options
such as adding skim milk powder to breakfast milk, biscuits and snacks or toast, butter
and jam; nourishing drinks such as coffee made on milk. The hospital may supply oral
supplements and these can be included in the meal plan.
Note: Providing a detailed meal plan is a useful way of demonstrating your
implementation plan, but still detailing priorities is important.
Suggest help groups such as meals on wheels, meal programs, shopping or cooking
services etc
Ensure practical, realistic and feasible strategies and support provided
Note: ensure that your implementation plan is designed to meet the goals you set in
question 2 above. That is can the suggested meal plan provide enough energy and protein
to achieve restoration of nutritional status and weight gain?
4. Prepare a plan to evaluate the effectiveness of your intervention.
Measures to monitor:
o Anthropometry – increased weight, waist measurements, skin-fold thickness
o Biochemistry – Appropriate albumin levels and iron status achieved and or
maintained
o Clinical - symptoms to diminish, improvement in general well being
o Dietary – can identify changes required, (knowledge), diet history indicates
better food choices and intake, improvements in attitudes, skills and behaviour
changes eg cooking methods, label reading OR if in hospital monitor food
intake via food record.
Short term vs long term goals considered
Time line provided (that is what are the expected changes and over what time frame?)
Recording or documentation noted
Consider process ( client satisfaction, willingness and actual returning or providing
feedback) and effectiveness ( achievement of goals and objectives set)
Could include contingency plan for failure to attend. Interpretation of failure to attend
follow up. In this case you need to describe a contingency plan for failure of client in
achieving adequate food intake.