Berina Dumanjic
DIE3213:80757
October 1, 2014
Case Study #1
Questions:
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)
145 𝑙𝑏𝑠.
Weight= 145 lbs. = 2.2 𝑘𝑔 = 65.9 kg = 66 kg
2.54 𝑐𝑚
Height= 5’2 = 62 inches = 62 in. x 1 𝑖𝑛. = 157.5 cm
%IBW= 45.5kg + 2.3kg + 2.3kg= 50.1kg
66
%IBW= 50 x 100%= 132%
66
%UBW= 70 x 100%= 94%
𝑤𝑒𝑖𝑔ℎ𝑡 (𝑘𝑔)
BMI= ℎ𝑒𝑖𝑔ℎ𝑡 (𝑚2 )
66 𝑘𝑔
BMI= (1.75 𝑚2 ) = 26.6
Her current weight is 145 lbs. (66kg), which gives her a BMI of 26.6 meaning she is classified as
overweight. After calculating her ideal body weight, which was 110 lbs. (50.1kg), she is 132% over her
ideal body weight. In addition to, after calculating her usual body weight, which was 94%, she is
considered mildly malnourished.1
2. Calculate her nutritional requirements (calories, protein, and fluid) and compare her current
intake to her needs. (5 points)



Protein: 66kg x 1.0 = 66 kg/day
Fluid: 1 mL x 2116 kcal = 2116 mL/kcal
Calories:
o Allowance  1600 kcal
o Intake  2116
According to the SuperTracker, Marian’s required intake is 1600. However, she has consumed 2116
based off of her diet history information. She has met her daily needs for grains, 1 ¾ cups veggies, 1 ¾
cups fruits, 2 cups dairy (under), and 13 oz. of protein (over). Her RDA for oils is 5 tsp. and she’s only
consumed 2 tsp. Her RDA for saturated fat is 18g and she’s consumed 29g, and her RDA for sodium is
1500mg and she’s consumed 1448mg.2
3. Are any major food groups and nutrients obviously missing from her diet? Explain your answer.
(5 points)
Based on Marian’s food report, she’s eating foods from each food group, however, she’s eating
more refined grains than whole grains, more canned fruits and vegetables instead of fresh. She’s also
“under” the recommended amount of dairy. The RDA dairy for Marian is 3 cups and she’s only
consumed 2 cups, which has been all whole milk.
The nutrients that are “under” the RDA are carbohydrates. She’s consumed 43% off the 45-65%
recommended amount. Her dietary fiber is under as well. She’s consumed 18g, but her target is 21g. Her
linoleic acid target is 11g, but she’s only consumed 8g. Her alpha-linoleic acid target is 1.1g, but she’s
only consumed 1.0g.
The following minerals are under in Marian’s diet; calcium, potassium, magnesium, and zinc.
The target for calcium is 1200mg, but she’s only consumed 771mg. Her potassium target is 4700mg, but
she’s only consumed 2867mg. Her target for magnesium is 320mg, but she’s only consumed 271mg.
Finally, her target for zinc is 8mg, but she’s only consumed 6mg.
The following vitamins are under in Marian’s diet; vitamin A, C, D, E, K and choline. Her target
for vitamin A is 770 micrograms per RAE, but she’s only consumed 491 micrograms per RAE. Her
target for vitamin C is 75mg, but she’s only consumed 44mg. Her target for vitamin D is 15 micrograms,
but she’s only consumed 8micrograms. Her target for vitamin E is 15mg, but she’s only consumed 4mg.
Her target for vitamin K is 90 micrograms, but she’s only consumed 36 micrograms. Finally, her target
for choline is 425mg, but she’s only consumed 140mg.3
4. Do you think she could be experiencing any drug–nutrient interactions? If so, what dietary
suggestions would you make? (5 points)
Yes, Marian is experiencing drug-nutrient interactions. To start off, she’s taking bumex, which is
a potent diuretic which can lead to diuresis with water and electrolyte depletion4. In addition to, she’s
consuming kaopectate, which decrease potassium, gives false positive glucose levels, and it’s not
recommended for individuals with hypertension or arthritis.5 Marian has osteoarthritis in her wrists and
ankles and she has hypertension with a current reading of 170/100. Lastly, Marian is consuming mineral
oil to help with “regularity” but she’s also consuming kaopectate which doesn’t help with regularity.
Some dietary suggestions for Marian would be to increase her fluid intake to at least 8 cups of
liquid (water, SF juice) per day when consuming bumex. In addition to, I would suggest consuming
foods that are high in potassium and calcium, such as bananas, white beans, salmon, dark leafy green
vegetables, and yogurt (plain). The increased intake in potassium and calcium will not only help her
with her osteoarthritis, but also with maintain her potassium and calcium levels while consuming
kaopectate.
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)
 Normal serum albumin range  3.5-5 g/dL
 Marian’s serum albumin level  3.2 g/dL
Some factors that may cause serum albumin levels to increase and/or decrease include liver disease
or acute inflammatory disease.6
 Normal prealbumin range  15-36 mg/dL
 Marian’s prealbumin level  11mg/dL
Some factors that may cause serum albumin levels to decrease include low levels of protein,
inflammation, malignancy, and protein wasting disease of the intestines or kidneys.
Some factors that may cause serum albumin levels increase include inflammatory stress, pregnancy,
proteinuria, and hypoproteinuria.7
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)
To start off, Marian’s anthropometric measurements are an important component of the
nutritional assessment which help a professional evaluate if she’s overnutrition or undernutrition. In
Marian’s situation her anthropometric measurements of height and weight allows a professional to see
that she’s mildly malnourished. Marian’s actual body weight gave insight on her weight loss over the
past month and how it may possibly reflects dehydration or inability to meet nutrition requirements.
Another anthropometric measurement that allows a professional to assess whether Marian’s weight is
appropriate for her height is with the body mass index (BMI). This measurement also determines
whether Marian is overnutrition or undernutrition, which in this case her BMI is 26.6 which classifies
her as overweight.
After the anthropometric measurements, the biochemical and clinical assessments gives a
professional a deeper insight on the nutrient availability in biological fluids and tissues. In Marian’s
situation, her sodium levels are high; her glucose levels are high which can be an indicator of insulin
resistance; her creatinine is on the higher end of the reference range (0.5-1.1 mg/dL) which can be an
indicator of renal disease; her hemoglobin falls on the lower end of the reference range (12-16 g/dL)
which is decreased in those with renal disease or who are taking certain drugs; her albumin levels fall on
the lower end of the reference range (3.5-5 mg/dL) which is known to decrease in those with liver
disease or acute inflammatory disease.8
Finally, her dietary nutritional assessment allows the professional to obtain dietary intake and
refers to a review of the patient’s usual patterns of food intake that affect health conditions and nutrition
risk. In Marian’s situation, her caloric intake is high, however, the foods that she’s consuming aren’t
high in nutritional content.
7. Write a PES statement based on the nutritional assessment data available.
(P)Involuntary weight loss related to (E) chronic diarrhea, feeling “sad” lately, and “not eating
well” as evidence by (S)10 lb. weight loss over a period of one month.
8. What dietary and social changes would you suggest to improve her nutritional intake? (5 points)
Some dietary changes that I would suggest for Marian to improve her nutritional intake include
consuming 2 cups of whole fresh dark-green leafy vegetables and 1 ½ cups of whole fresh fruits,
especially those that are high in potassium, calcium, vitamin A, C, D, E, and K. Also, I would suggest
consuming more whole grains instead of refined grains. I’d recommend 5 oz. of whole grains, such as
brown rice, whole wheat pasta, quinoa, oatmeal, or whole wheat bread. And lastly, I would suggest for
her to increase her fluid intake and not just drinking whole milk. I’d recommend water or sugar-free
juices. In addition to, I’d suggest some nutrition-related medication management because she’s taking
three different Rx medications along with self-prescribed mineral oil for “regularity.”
Some social changes that I’d recommend for Marian is to eat in a group setting at least twice a
day and then once a day with a family member. Marian stated that she’s feeling more “sad” than usual,
which is an important factor since she’s living in an acute care facility.
9. What are your nutritional goals for her, and how would you monitor the effectiveness of your
interventions from question #8? (5 points)
Nutritional Goals:9
i. Indicator: Food Intake
1. Criteria: Marian will consume >50% of her 3 meals/day within a group setting or
with a family member
ii. Indicator: Food Intake
iii. Indicator: Fluid Intake
1. Criteria: Consume 8 cups of fluids (water or sugar-free juices)
iv. Indicator: Meal Set-Up
1. Criteria: Follow the guidelines from MyPlate, where half of Marian’s plate will be
fresh fruits and vegetables along with a cup of water to go along with the meal.
Monitoring:
RD will complete weekly weight measurements, biochemical assessments, and have the
patient keep a daily diet diary/log. .
10. Write a note documenting your assessment in SOAP format. (5 points)
a. S (SUBJECTIVE):
i. Weight loss of 10 lbs. over a period of one month
ii. “being more sad than usual”
iii. Teeth are in “poor condition”
b. O (OBJECTIVE):
i. Height  157.5 cm
ii. Weight  66 kg
iii. %IBW  132%
iv. %UBW  94%
v. Diet related meds:
1. Kaopectate for diarrhea
vi. Estimated nutrients needs  1600 kcal
c. A (ASSESSMENT):
i. Abnormalities of lab results  sodium, glucose, creatinine, hemoglobin, albumin
ii. Comments on diet hx  high caloric intake, not enough fresh whole fruits and
vegetables, more refrained grains instead of whole grains, high sodium intake, low fluid
intake
d. P (PLAN):
i. Request for calorie count
ii. Suggested changes for diet
1. Eating >50% of her 3 meals/day in a group setting and with a family member
2. Half of her plate needs to be fresh whole fruits and vegetables
3. Having a cup of water or sugar-free juice by her night stand when she wakes up
when she starts her day and while eating her each of her meals
iii. Rx
1. Have Marian F/U with her doctors on the medications she’s taking along with the
self-prescribed mineral oil.
iv. F/U
References:
1. Mahan K., Escott-Stump S., Raymond J. Clinical: Inflammation, Physical, and Functional Assessments.
Food and the Nutrition Care Process. 13th ed. St. Louis, MO. Elsevier Saunders; 2012:165-167.
2. Nutrient Intake Report. Supertracker: ChooseMyPlate Website. Available at
https://www.supertracker.usda.gov/NutrientsReport.aspx?Popup=True&ReportActivityDate=9/27/2014.
Accessed September 2014.
3. Nutrient Intake Report. Supertracker: ChooseMyPlate Website. Available at
https://www.supertracker.usda.gov/NutrientsReport.aspx?Popup=True&ReportActivityDate=9/27/2014.
Accessed September 2014.
4. Bumex. RxList: The Internet Drug Index Website. Available at http://www.rxlist.com/bumex-drug.html.
Accessed September 2014.
5. Kaopectate. WebMD Website. Available at http://www.webmd.com/drugs/2/drug-525/kaopectate-1-d-loperamide--oral/details. Accessed September 2014.
6. Mahan K., Escott-Stump S., Raymond J. Appendixes. Food and the Nutrition Care Process. 13th ed. St.
Lous, MO. Elsevier Saunders; 2012:1082.
7. Mahan K., Escott-Stump S., Raymond J. Appendixes. Food and the Nutrition Care Process. 13th ed. St.
Lous, MO. Elsevier Saunders; 2012:1083.
8. Mahan K., Escott-Stump S., Raymond J. Clinical: Biochemical Assessment. Food and the Nutrition
Care Process. 13th ed. St. Lous, MO. Elsevier Saunders; 2012:194-195.
9. Mahan K., Escott-Stump S., Raymond J. Appendix 5. Food and the Nutrition Care Process. 13th ed. St.
Lous, MO. Elsevier Saunders; 2012:1048-1050.