Tala L. Moshref 3772014 NUTR 302 Lab NPC Assignment 3 Nutrition Care Process (NCP) Nutrition Assessment (3 pt) x? © Diagnosis: ron deficiency/Anemia ‘+ Nutrition-related PMH, treatments, surgeries: N/A ‘+ Age, gender: 22 years old female + Dietary intake Food preferences, allergies, intolerances: “healthy diet” vegiterian. Exercise habits: N/A Knowledge, readiness for change: N/A Functional/behavioral factors: has stopped taking vitamin/mineral supplements prescribed by doctor, ‘+ Resources for obtaining, preparing food: N/A © Symptoms: fatigue + Ht/wt, BMI, IBW (use Hamwi formula, #1 on p. 112), %IBW, UBW, SUBW, %wt change — assess weight status, degree of malnutrition/depletion Height: 5°4” and weight is 108 Ib’s BMI: Weight (kg)/height (m) = (48kg) 1 (1.63m)*=18.4 kgim ? low BMI IBW: 1001b+20b(adding 5 b's for each additional inch)=120lb %6IBW: Current weight/ideal body weightx100 108/120 x 100=90% Mild depletion UBW: N/A S6UBW: N/A se wt change: N/A ‘+ Energy, protein and fluid needs Energy needs: weight (kg) x .95kcal/kg x 2ahr = 49kg x .95kcal/kg x 24hr = 1117.2 REE REE x activity factor x stress factor = (1117.2 x 1.3 x 1)+500 cal added for lactating= 1952 Protein needs: weight in kg x gm protein/kg = protein needs/d (49 kg x.8 gm )+15 gm (first 6 months lactating) protein/kg = 54 gm protein/d (49 kg x 1.0 gm)+15gm (first months lactating) protein/kg= 64 em/protein/d if she is inthe first 6 months of lactating, her protein needs are between 54-64 gm/d. (49 kg x.8 gm)+12em (more than 6 months lactating) protein/kg= 51 gm proteln/d (49 kg x 1.0 gm)+12gm (more than 6 months lactating) protein/kg= 61 gm protein/d IF she is beyond the first 6 months her protein needs are between 51-61 gm/d.. Fluid needs: for adolescents a range between 40-60 mi/kg/day is considered, 40mi/ke/day x 49 actual body weight (kg) = 1960 mi/d 60mi/ke/day x 49kg = 2940 mi/a The average of fluid needs is 2450 mi/d ‘* _ Labs/tests ~ can indicate high or low, normal or abnormal Hemoglobin levels are 9.5 gm/dl, The levels are lower than the normal range of 12-16 gm/dl. Hematocrit levels are 30% which is below the normal range of 37-47%. * Medications/supplements: stopped taking vitamins and minerals © Skin integrity:N/Aintake/output (1/0): Lactating * Bowel movements (BM):N/A Nutrition Diagnosis (3 pts} x2 PES format: tron deficiency R/T inadequate protein intake and discontinuation of. vitamin/minerals supplements and inadequate vitamin B12, folate and inadequate mineral intake zinc from diet, AEB fatigue, weight loss, low hemoglobin and hematocrit levels and. BMI of 18.4 and laW 0%, Nutrition intervention (3 pts) x? Use handout for terminology; then specify. Use REC If RD cannot prescribe, Include SMART (specific, ‘measurable, attainable, relevant, time-bound) goals. Consumption of food and snacks: Iron rich vegetarian dlet (dark leafy vegetables and cooked spinach porsumed with vitamin C for better absorption. Purchasing iron enriched products such as cereals and baked goods. Regular consumption of whole grains and legumes and seeds as well as reguler Consumption of food based protein such as a variety of soy products (tofu,tempeh,etc). REC iron Shoplementif approved by physician and stating to take vitamins and minerals recommended by doctor. Nutrition Education: Learning about the importance of a balanced diet during lactation. Learning about rich sources of plant proteins since she is following a vegetarian diet. Goals: Increasing the amounts of high protein plant sources immediately (nuts and seeds, legumes, soy products). Starting to take the vitamins and minerals ‘supplement recommended by her doctor immediately. Gradually returning to normal levels of hemoglobin and hematocrit in 6-8 weeks. ah Nutrition Monitoring and Evaluation When will you re-assess? Will re-assess in two weeks and offer more suggestions if needed. ‘What will you monitor? | will ask patient to fill out a FFQ of plant based proteins sources consumed during the week, Will monitor blood hemoglobin and hematocrit levels and re-evaluate fatigue levels. How will you evaluate outcomes? By referring to the FFQ and new test results.Tala L. Moshref 3/7/2014 NUTR 302 Lab Ge) NPC Assignment 2 Nutrition Care Process (NCP) Nutrition Assessment (3 pts) ‘* Diagnosis: Type 1 Diabetes Mellitus Nutrition-related PMH, treatments, surgeri Age, gender: 24 years old male Dietary intake: No breakfast. Lunch and dinner every day plus snacks three or four times a day. Lunch is typically a hamburger, fries and a large soda and dinner is a frozen meal or pizza, desert and a soda. He snacks on chips, cookies and snack cakes. No consumption of fresh fruits and : Frequent urination, excessive thirst and hunger vegetables. e Food preferences, allergies, intolerances: ready to eat, fast food x Exercise habits: infrequent, once a week. Knowledge, readiness for change: Does not monitor blood glucose levels regularly but does come in for regular check-ups. The knowledge is there but is not enough. * Functional/behavioral factors: Not exercising regularly and not monitoring blood suger levels regularly (checks once or twice a week). Resources for obtaining, preparing food: N/A ‘Symptoms: Excessive thirst and hunger, frequent urination. Ht/wt, BMI, IBW (use Hamwi formula, #1 on p. 112), %IBW, UBW, %UBW, %wt change — ‘assess weight status, degree of malnutrition/depletion Height: 5°10” and weight is 165Ib’s BMI: Weight (kg)/height (m) * (75kg) / (1.78m)?= 23.67 kgm? IBW: (1061Ib) +(10x6)= 166 Ib %6IBW: Current weight/ideal body weightx100 1651b/166Ibx100=99.4% (between ideal range of 90-105%) UBW: N/A %UBW: N/A % wt change: N/A Actual weight is very close to ideal body weight but the diet is unhealthy. ‘+ Energy, protein and fluid needs Energy needs: weight (kg) x 1kcal/kg x 2ahr = 75kg x 1kcal/kg x 24hr=1800+ (200}=2000 REE REE x activity factor x stress factor= 2000 x 1.3 x (1) = 2600 kcal/day Protein needs: weight in kg x gm protein/kg = protein needs/d 75 kg x.8 gm protein/kg = 60 gm protein/d 75 kg x 1.0 gm protein/kg= 75 gm protein/d Patient is at anon stressed state (.8 - 1.0 gm protein/kg. He needs between 60-75 gm protein/d. Fluid needs: mi/ke/day x actual body weight (kg) = mi/d 35 mi/kg/day x 75 kg = 2625 mi/d or 2.7L/d + Labs/tests - can indicate high or low, normal or abnormal Hgb: 14.7 g/dl which is between the normal ranges of 14-18 gr/dl. Het: 44%, which is between the normal ranges of 40-54%,Albumin: 4.3 g/dl, which is also in the normal range of 3.5-5.0 g/dl. Glycosylated Hemoglobin: 9.4% which is high. It should be < 6.5%. Fasting Blood glucose levels are 180 mg/dl which is high. It should be between 70-110. Medications/supplements: Insulin shots ‘Skin integrity: N/A Fluid intake/output (1/0): excessive thirst and frequent urination Bowel movements (BM):N/A Nutrition Diagnosis (3 pts) xD PES format: High blood glucose levels in patient R/t to food and nutrition knowledge deficiency, self monitoring deficiency and undesirable food choices AEB frequent urination, excessive hunger and thirst and 9.4% Glycosylated hemoglobin levels as well as 180 mg/dl of fasting glucose levels. Nutrition Intervention (3 pts) x2 Use handout for terminology; then specify. Use REC if RD cannot prescribe, Include SMART (specific, measurable, attainable, relevant, time-bound) goals. ‘Composition of foods and snacks: adding more whole grains, fruits and vegetables to diet. Following a Low fat and low glycemic index diet, lowering the consumption of fast food and monitoring the time and amount of carbohydrates consumption, adding healthy snacks. Priority modifications: replacing soda with water and desert with a fruit which will help to reduce the intake of high sugar foods. Self monitoring: checking blood glucose levels periodically and multiple times a day. Coordination of Nutrition Care: Referral to an exercise physiologist for regular physical activity and a diabetes specialist for learning about the disease and ways to monitor it through diet. Goals: Starting to monitor blood glucose levels three times a day before meals. Beginning a regular physical activity program by next visit. Gradually reduce the amounts of Glycosylated Hemoglobin to 6.5% in10-12 weeks. Nutrition Monitoring and Evaluation x\ When will you re-assess? Re-assess in two weeks What will you monitor? Lab reports including levels of blood glucose and Glycosylated hemoglobin, Also, will ask about the levels of thirst, hunger and urination, How will you evaluate outcomes? New lab tests and food logTala Moshref Nutrition 302L March 28, 2014 Nutrition Analysis, Results of 24hr. recall dietary analysis using Diet Analysis Plus software Calories: DRI: 2453 kcal — Actual intake 1687.78 kcal Macronut nts: CHO: DRI is 270-390 kcal - Actual intake 147.24 keal Fiber: DRI is 25 gr/day - Actual intake 20.19 gr Sugar: No DRI (very low amounts is recomended) — Actual intake 55.55gr Protein: DRI 59.87 gr/day ~ Actual intake 76.36 gr Fat: DRI 53-93 griday — Actual intake 88.94gr Saturated fat: DRI is less than 24 gr/d — Actual intake 24.84gr Vitamins and Minerals: A: DRI is 700 pig — Actual intake 178.13 1g C: DRI is 75 gr— Actual intake 94.78 gr D: DRI is 15ug— Actual intake 3.734g Iron: DRI is 18 gr— Actual intake 10.03 gr Calcium: DRI is 1000gr— Actual intake 673.78gr Potassium: DRI is 4700 gr — Actual intake is 1503.61 gr Sodium: DRI is 1500 gr — Actual intake is 2000.78 grAccording to the Diet Analysis Program my daily recommended intake is 2453 kcal per day considering my activity levels. Surprisingly, my intake that day was lower ‘han the recommended amount (1687.78 keal) which usually does not happen. This Program recommended 59.87 gr of protein and I actually | exceeded the amounts by 16.49 ar extra protein intake, The amount of fat recommended is between 53-93 gr per Ave 2.244 (UWW) Boal dene Bae nto W (kg) bso) Toue Bodydensityis == \ BW — UW (ka) RV. Ba 2.28 (ee) Toa. aan) A466 0.99567 0. —oaer (a 5Bx16% 55.45 SH ANFCO. S45 F Body fat * BW: Body weight 2 ees UWW: Under water weight 1 ee fs vi 3) 50 = 15:6 Body Fat: 4-28 kg,__\“ _% (* Use Siri Equation on Lae Rinaal § ce 81) Lean Body Mass: 42.32 kg, 4% Comment: Compare the values of % Body fat using the different methods (A)}-(D). Bel Ral oly Fe 1.4 :Part 1 comment: The subject's current weight is 128Ib’s (58kg) which is 95% of her ideal body weight. This percentage indicates that she is within the “ideal” category whi between90-105%, Referring to the Life Insurance Table the subject is considered to have a small frame. With her height of 5°7” she does not seem like having a small frame. I agree with the lab manual table on page 92-2 considering her having a medium frame. Part 3 comment: The subject has a waist to hip ratio of .79 which meets the preferred value of <0.8. This range is considered healthy so the chance of cardiovascular diseases is low in subject. L Last page comment: In calculating % body fat with measuring cireumferences the results were 20%. ‘This was different from what was calculated with Bioelectrical Impedance Analysis (BIA). The results from BIA were 22%, These seemed a bit high when compared to the results with three and seven site skin folds. Body fat % from 3 skin fold measurements resulted in 12%. Also, the body fat % ftom 7 skin fold measurements resulted in 14%. However, the % body fat measurements from Hydrostatic weighting resulted in 16%. Lastly, the % body fat measured with the Bod Pod resulted in 14.4%, The high percentage calculated by BIA could be an error depending on hydration levels of the subject. As far as the skin fold measurements, the percentages calculated could be incorrect due to lack of experience of the person doing the measurements. Afterall, Hydrostatic weighting is the most accurate method of measurement to estimate body fat and = Wear emtd adh 49 ees hatty Wir Wignms © oe fs ad)" (%* ge this is what will be considered as accurate measurement.