Your name: Melissa Moser
Class: Nutrition Therapy 1
Instructor: Janine Dray
Date: September 13, 2013
CASE 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)
IBW=100lb.+5(7)=135lb.(1kg./2.2lb.)=61.36kg.
%IBW= (actual BW/ideal BW)x100=(63.64kg./61.36kg.)x100=103.71% adequate range
%UBW=(actual weight/usual weight)x100=(140/160)x100=87.5%
UBW(kg.)=160/2.2=72.73kg.
ABW(kg)=140/2.2=63.64kg.
BMI=weight (kg.)/height (cm)= (140/2.2)/(170.18𝑐𝑚. )2=63.64kg./28961.2324cm.
squared=.0022 𝑘𝑔./𝑐𝑚.2 normal BMI
𝑈𝐵𝑊−𝐴𝐵𝑊
72.73𝑘𝑔.−63.64𝑘𝑔.
weight change= 𝑈𝐵𝑊 𝑥100 =
𝑥100 = 12.5% 𝑤𝑒𝑖𝑔ℎ𝑡 𝑙𝑜𝑠𝑠 in 6 months
72.73𝑘𝑔.
2. Calculate her nutritional requirements (calories, protein, and fluid) and compare her
current intake to her needs. (5 points)
Harris-Benedict
BEE=655.1+9.6(63.64)+1.85(170.18)-4.7(76)=655.1+310.944+314.833-357.2=923.677(1.2
confined to bed activity factor)=1108.41 Kcal/day
Mifflin
9.99(63.64)+6.25(170.18)-4.92(76)-161=635.7636+1063.625-373.92-161=1164.4686(1.2)=
1397.36 Kcal/day
Rule of thumb for weight gain: 35-40Kcal/kg=2227.4-2545.6 Kcal
Protein RDA: .8g/kg body weight=50.912g
Protein RDA (adjusted for trauma: femur fracture)=1-1.5 g/kg=63.64-95.46g
Protein-Kilocalorie ratio= approx. 1:20
Protein DRI(for repletion)=1.3-1.8g/kg=82.73-114.55g
Normal fluid needs=25-35mL/kg ABW=1591-2227.4mL
This woman is not consuming nearly enough Kcal/day to maintain or achieve weight gain. After
entering her usual diet information into a diet analysis program, it was reported that she is only
consuming about 1068 Kcal/day. According to the Mifflin equation, she needs to consume at
least 1397.36 Kcal/day to maintain bodily functions. She has lost a significant amount of weight
in six months which is labeled as severe weight loss. She is consuming about 48grams of
protein/day which is below her recommended protein intake for repletion. She usually consumes
828.058mL (3.5𝑐.× 236.588𝑚𝐿) of fluids per day.1 She needs to consume about 800-1500mL
1
US cups to Milliliters Table. Metric Conversions website. Available at http://www.metricconversions.org/volume/us-cups-to-milliliters-table.htm. Accessed September 13, 2013.
more fluids throughout her day. Since she does not prefer to drink milk due to food preferences,
her usual calcium intake is significantly lower than her DRI.2
3. Are any major food groups and nutrients obviously missing from her diet? Explain your
answer. (5 points)
She is neglecting her dairy food group. The only source of dairy that she consumes on a regular
basis would be the cream to sweeten her tea and the margarine to spread on her toast. Overall,
she consumes a little of every food group with a slice of toast for grains, a tablespoon of peanut
butter and chicken for protein, peaches, and carrots or spinach for fruits and vegetables. She is
lacking in her calcium and vitamin D intake due to her avoidance of milk. She is also lacking in
vitamin B12 because she is not consuming seafood like shellfish and fin fish as well as meat and
dairy.3
4. Do you think she could be experiencing any drug–nutrient interactions? If so, what
dietary suggestions would you make? (5 points)
The only medication she is taking is furosemide. This drug is a diuretic and used to treat
hypertension. Furosemide can cause her mouth to be dry because one of the symptoms for this
drug is mouth irritation. Also, her dehydration can be caused from taking this drug because it
causes her to urine more frequently than normal.4
She should consume foods with more vitamin K. Taking vitamin K in supplement form may
interfere with furosemide. Foods with high amounts of vitamin K would be vegetables like
asparagus and broccoli or spinach since she already eats a serving of spinach for dinner.5 She
can include a banana and freshly sliced peaches in her lunch. To decrease her sodium intake, she
should substitute canned soups for stewed vegetables with beans or chicken. Drinking water
between or with meals can help decrease sodium through excretion.
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)
She is not consuming enough protein on a regular basis to produce normal prealbumin and
albumin levels. Her broken femur is also adding to her protein deficiency due to inflammation
and the c-reactive protein. A protein supplement and consuming whole cooked eggs that may be
disguised in an entrée would increase her albumin and prealbumin levels.
2
Diet Analysis Plus [computer program]. Version 9. Cengage Learning; 2008.
Traister J. The Best Sources of Vitamins B6 and B12. Livestrong Website. 2011. Available at:
http://www.livestrong.com/article/387151-the-best-sources-of-vitamins-b6-b12/. Accessed September 13, 2013.
4
Pronsky Z, Crowe J. Food Medication Interactions. Pennsylvania: Food Medication Interactions;2012.
5
Vitamins and Supplements Lifestyle Guide. Webmd Website. http://www.webmd.com/vitamins-andsupplements/lifestyle-guide-11/supplement-guide-vitamin-k. Accessed September 14, 2013.
3
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)
Her weight has dropped significantly below her UBW because she is grieving the recent loss of
her husband. She does not have anyone to share meals with and she might be living alone with
physical disabilities that keep her from being able to prepare healthy meals. Due to her physical
and emotional condition, she is unable to eat much protein, which is the only thing that is lower
than normal in her biochemical data. She is dehydrated because of her inadequate intake of
fluids. Her overall nutritional health is poor for her age and conditions.
7. Write a PES statement based on the nutritional assessment data available.
(5 points)
Inadequate oral food and beverage intake related to poor emotional and physical conditions as
evidenced by severe weight loss of 12.5% in UBW and lower than normal albumin and
prealbumin levels.
8. What dietary and social changes would you suggest to improve her nutritional intake? (5
points)
To improve her nutritional intake, she should maintain a healthy routine. She can go to the
senior center or a senior living community to have social interaction with relatable people. She
is feeling lonely now and having friends and neighbors to talk to and share mealtimes and food
preferences would encourage her to eat more types of foods. Enrolling in a “meals on wheels”
program would help provide at least one nutritious meal for her. I would suggest consuming
easily prepared snacks, especially fruits like bananas and oranges to increase her potassium
levels. Depending on her mobility after she is discharged from the hospital, I would recommend
her living in an assisted living community or with any relatives willing to monitor her nutritional
intake and wellbeing.
9. What are your nutritional goals for her, and how would you monitor the effectiveness of
your interventions from question #8? (5 points)
I would want to see her eating a variety of foods rather than a usual daily diet. I would want her
to stop eating canned soups and go for fresh fruits and vegetables. Also, I want her to drink
more water and fluids with and between meals. She needs more complete proteins in her diet
like eggs and peanut butter. As an inpatient, her meals will contain steamed vegetables, protein
through foods like beans and peanut butter sandwiches, dairy items such as yogurt because of its
soft texture and her dislike of milk, and fruits like bananas for snacking. Since her dentures are
loosely fitted, I would contact an orthodontist and request to get her fitted dentures to encourage
her to eat a more varied diet. Before she is discharged from the hospital, I would test her
biochemical status again to see if her albumin and prealbumin levels have returned within the
normal range. I would set up for her to receive nutritious meals delivered to her home at least
once a day. Also, I would suggest that she lives with relatives or a community where senior
assistance is available.
10. Write a note documenting your assessment in SOAP format. (5 points)
Subjective:
 Recent loss of spouse, depression
 Same eating pattern daily, no drinks or snacks between meals
 Does not like eggs or milk
Objective:
 67 inches, 140 lbs., BW weight before husband passed away: 160 lbs.
 12.5% weight loss in 6 months
 BEE=1397.36 kcal/day
 Albumin and prealbumin levels below normal range
 20 mg. furosemide daily
 Estimated kcal/day needed for weight gain=2227.4-2545.6 Kcal
 Femoral fracture, confined to bed
 Decreased skin turgor
 Loosely fitting dentures
Assessment:
 Lack of protein for timely healing of broken femur
 Not consuming enough kcal/day to maintain a healthy weight
 Physical limitations to preparing meals
 Not enough fruits and vegetables
 Not enough fluids and water
 Depression and lack of help in daily life
Plan:
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Increase potassium levels
Decrease sodium levels
Increase fluid intake
Encourage snacking and drinking between meals
Enrolling in helpful nutrition programs for the elderly
Enlisting someone for assistance during daily activities
Increase albumin and prealbumin levels to normal range before discharge from hospital
References (AMA format)
US cups to Milliliters Table. Metric Conversions website. Available at http://www.metricconversions.org/volume/us-cups-to-milliliters-table.htm. Accessed September 13, 2013.
Diet Analysis Plus [computer program]. Version 9. Cengage Learning; 2008.
Traister J. The Best Sources of Vitamins B6 and B12. Livestrong Website. 2011. Available at:
http://www.livestrong.com/article/387151-the-best-sources-of-vitamins-b6-b12/. Accessed
September 13, 2013.
Pronsky Z, Crowe J. Food Medication Interactions. Pennsylvania: Food Medication
Interactions;2012.
Vitamins and Supplements Lifestyle Guide. Webmd Website.
http://www.webmd.com/vitamins-and-supplements/lifestyle-guide-11/supplement-guidevitamin-k. Accessed September 14, 2013.
Emery E. Clinical Case Studies for the Nutrition Care Process. Massahusetts: Jones & Bartlett
Learning; 2012.