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Kerry Linne

2/12/17
N302L Case Studies
Nutrition Care Process (NCP): Albumin

Nutrition Assessment

 Diagnosis: Bladder cancer


 Nutrition- related PMH, treatments, surgeries: Chemotherapy
 Age, Gender: 55, female
 Dietary intake: PO intake
 Food preferences, allergies, intolerances: None known
 Exercise habits: None known
 Knowledge, readiness for change: seeks aid in keeping food down
 Functional/behavioral factors: Unknown
 Resources for obtaining, preparing food: Unknown
 Symptoms: Nausea, vomiting, lack of appetite
 Anthropometric measurements
o Ht/wt: 65 in/ 165.1 cm and 112 lbs/ 50.8 kg
o BMI: 18.7 kg/m^ (normal)
o IBW= 125 lbs (mild malnutrition)
 5’=100#, 5’’x5#=25, 100+25=125 lbs
 112#/125#= 0.896 x 100= 89.6% (mild malnutrition)
o UBW= 123 lbs (mild malnutrition)
 112/123= .91x100= 91.1%
o % Weight loss= 8.9% (mild degree of malnutrition)

Energy, protein and fluid needs

 Total Energy= 1998-2306 kcal/day


o Used Harris-Benedict formula to determine REE then multiplied by activity
(1.3) & injury factor (1.3-1.5)
 Protein= 50.9-63.6 g/day
o Used stress factor for tumor: 1.0-1.25 g Pro/kg
 Fluid= 1.8 L/day
o Used 35 ml/kg/day

Labs/tests- can indicate high or low, normal or abnormal

 Total PRO= 5.5 g/dL, low (<6.0g/dL)


 Serum albumin= 2.8 g/dL, low (<3.8 g/dL)
 Glucose: 83 mg/dl
 Bun: 15 mg/dl
 Hgb: 12.2 g/dl
 Hct: 37%

Medications/supplements: Chemotherapy
Nutrition Diagnosis- PES format

 Inadequate protein intake related to poor appetite and nausea/vomiting caused by


chemotherapy (AEB) <90% IBW, 8.9% weight loss, low total protein (5.5 g/dL) and
low serum albumin (2.8 g/dL).

Nutrition Intervention
 Meals and snacks
o Breakfast- fruit smoothie with protein powder
o Lunch- quinoa salad with lean protein (fish or chicken)
o Dinner- Brown rice, roasted vegetables, lean protein
o Snacks- almonds, protein bars, protein shake
 Nutrition-related medication management
o REC appetite stimulant

Goals
1) Dietary intake to meet > 75% of DRI needs
2) Weight gain of 1 pound per week until reaching UBW/IBW
3) Increase total protein and serum albumin to normal ranges
Nutrition Monitoring and Evaluation
1) Keep dietary food log
2) Follow up appointment in 3-4 weeks
3) Get new blood work in 3-4 weeks to measure serum albumin and total protein levels
4) Follow up phone call in 2-3 days

Kerry Linne
3/16/17
N302L Case Studies
Nutrition Care Process (NCP): Calcium
Nutrition Assessment

 Age, Gender: 67, Male


 Dietary intake: PO intake
 Knowledge, readiness for change: Came to local health fair, concerned about general
health
 Anthropometric measurements
o Ht/wt: 68 in/ 172.7 cm and 166 lbs/ 75.5 kg
o BMI: 25.5 kg/m2 (overweight)
o IBW: 154 lbs/70 kg
 5’= 106#, 8” x 6#= 48#, 106+48= 154 lbs
 166#/154#=1.08 x 100= 107.8% (ideal)

Energy, protein and fluid needs

 Total Energy= 1764.6-2156.8 kcal/d


o Used Harris-Benedict formula to determine REE then multiplied by activity
by 1.3 then plus or minus 10%
 Protein= 60.4-75.5 g/d
o Used non-stressed state of 0.8-1.0 g PRO/kg
 Fluid= 1.8-2.2 L/d
o Used 1 ml per kcal

Labs/tests- can indicate high or low, normal or abnormal

 Triglycerides: 89 mg/dl (normal)


 Serum albumin= 3.8 g/dl (normal)
 Glucose: 112 mg/dl (high)
 Cholesterol: 188 mg/dl (normal)
 Serum calcium: 9.8 mg/dl (normal)
 Urinary calcium: 300 mg over 24 hour period (high)
Nutrition Diagnosis- PES format

 Imbalance of nutrients R/T high sugar and high protein diet AEB high urinary
calcium (300 mg), glucose (112 mg) and BMI (25.5)

Nutrition Intervention

 Meals and snacks


o Breakfast- 2 egg omelet with spinach, broccoli, mushrooms, and peppers
o Lunch- Spinach salad with grilled salmon
o Dinner- Baked potato, roasted vegetables, and tofu
o Snacks- almonds and sardines with bones and crackers
 Nutrition-related medication management
o Take calcium supplements if food is not sufficient

Goals
1) Decrease body weight by 1-2 lbs/wk until IBW is reached or BMI is normal
2) Reduce protein intake to DRI recommended levels
3) Normalize urinary calcium levels within 2-3 weeks
4) Consume sufficient amounts of fluid to prevent dehydration given high volume of
urination

Nutrition Monitoring and Evaluation


1) Follow-up phone call within 1 week
2) Keep dietary food log for at least 3 days
3) Assess calcium intake and reduced protein levels
4) Reassess urinary calcium within 2-3 weeks

Kerry Linne
3/7/17
N302L Case Studies
Nutrition Care Process (NCP): Cholesterol
Nutrition Assessment

 Age, Gender: 39, male


 Dietary intake: PO intake
 Food preferences, allergies, intolerances: fast-food restaurants, cereal, whole milk
 Knowledge, readiness for change: yes, weight loss clinic
 Anthropometric measurements
o Ht/wt: 73 in/ 185.5 cm and 245 lbs/ 11.4 kg
o BMI: 32.5 kg/m2 (obese)
o IBW= 184 lbs/ 83.6 kg
 5’= 106#, 13” x 6#= 78#, 106+78= 184 lbs
 245#/184#= 1.33 x 100= 133.2 % (obese)
o Adjusted body weight: 199.3 lbs/ 90.6 kg
 (245#-184#) x.25 + 184= 199.3 lbs

Energy, protein and fluid needs

 Total Energy= 2,718-3171 kcal/d


o 30-35 kcal/kg
 Protein= 72.5-90.6 g/d
o Used non-stressed state for 0.8-1.0 g PRO/kg
 Fluid= 2.72-3.2 L/d
o Used 1 ml per kcal

Labs/tests- can indicate high or low, normal or abnormal

 Serum albumin= 4.5 g/dl (normal)


 Glucose: 93 mg/dl (normal)
 Triglyceride: 123 mg/dl (normal)
 Hgb: 15.2 g/dl (normal)
 Hct: 43% (normal)
 Total cholesterol: 240 mg/dl (high)

Nutrition Diagnosis- PES format

Obesity R/T excessive fat and energy intake and physical inactivity AEB high total cholesterol (240
mg/dl), %IBW (133.2), and BMI (32.5).

Nutrition Intervention

 Meals and snacks


o Breakfast- Whole wheat toast with avocado, non-fat yogurt, fresh berries
o Lunch- spinach salad with grilled chicken, tomatoes, peppers, and almonds
o Dinner- Baked potato, roasted vegetables, grilled salmon
o Snacks- fruit, vegetables, hummus, low-fat smoothie
 Nutrition-related medication management
o Refer to exercise physiologist for appropriate exercise routine
o Nutrition education

Goals
1) Decrease body weight by 1-2 lbs/wk until IBW is reached or BMI is normal
2) Normalize triglyceride values within 3-4 months
3) Begin regular exercise routine within 1-2 weeks
4) Lower kcal consumption within 1 week to recommended levels

Nutrition Monitoring and Evaluation


1) Follow up phone call within 1 week
2) Keep dietary food log for at least 3 days
3) Get new blood work in 3-4 months to assess cholesterol levels
4) Check in weekly to see how exercise routine is going

Kerry Linne
3/2/17
N302L Case Studies
Nutrition Care Process (NCP): Diet lab
Nutrition Assessment

 Age, Gender: 28, male


 Dietary intake: PO intake
 Exercise habits: moderate exercise (weight lifting)
 Resources for obtaining, preparing food: farmers markets, home cooked meals
 Anthropometric measurements
o Ht/wt: 71 in/ 180.3 cm and 205 lbs/ 93 kg
o BMI: 28.6 kg/m2 (overweight)
o IBW= 172 lbs/ 78.2 kg
 5’=106#, 11’ x 6#= 66#, 106+66= 172 lbs
 205#/172#=1.19x100= 119 % (overweight)

Energy, protein and fluid needs

 Total Energy= 2399.4-2932.6 kcal/d


o Used Harris-Benedict formula to determine REE then multiplied by activity
level (1.3) then plus or minus 10%
 Protein= 74.4-93 g/d
o Used non stressed state: 0.8-1.0 g PRO/kg
 Fluid= 3.3 L/d
o Used 35 ml/kg/day

Nutrition Diagnosis- PES format

Inadequate fiber, Vitamin A, and Calcium intake R/T low energy consumption AEB 24-hour food
recall and nutrient analysis fiber (58%), Vitamin A (40%), Calcium (58%), and total energy (49.6%)
of DRIs.

Nutrition Intervention

 Meals and snacks


o Breakfast- Whole wheat toast with avocado, non-fat yogurt, fresh fruit
o Lunch- Brown rice, roasted vegetables, grilled salmon
o Dinner- Baked potato, side salad, roasted chicken, non-fat cottage cheese
o Snacks- almonds, rice cake, protein shake

Goals
1) Decrease body weight by 1-2 lbs/wk until IBW is reached or BMI is normal
2) Increase fiber, Calcium, and Vitamin A consumption to recommended levels
3) Increase total energy intake to recommended levels

Nutrition Monitoring and Evaluation


1) Follow-up phone call within a week
2) Weigh food and record it in log
3) Record a 3-day food log
4) Revisit the lab in 2 weeks

Table 1. Nutrient Intake Data for 24-hr Recall


Energy CHO Fiber Fat Sat. Fat Pro Vit.A Vit.D Vit.C Iron Ca Sodium
(Kcal) (g) (g) (%Kcal) (%Kcal) (g) (ug) (ug) (mg) (mg) (mg) (mg)

Target 2600 130 38 25-35 <10 52 900 15 75 11 1300 <2300

Average 1289 166 22 21 3 93 359 30 401 8 760 1600


eaten
% DRI 49.6% 128% 58% 84% 30% 179% 40% 200% 535% 73% 58% 70%
Intake Low High Low Adequate Low High Low High High Adequate Low Adequate
Status

Kerry Linne
2/14/17
N302L Case Studies
Nutrition Care Process (NCP): Blood Glucose

Nutrition Assessment

 Diagnosis: Type 1 Diabetes mellitus


 Nutrition- related PMH, treatments, surgeries: None known
 Age, Gender: 24, male
 Dietary intake: PO intake
 Food preferences, allergies, intolerances: None known
 Exercise habits: basketball occasionally
 Knowledge, readiness for change: Unknown
 Functional/behavioral factors: Unknown
 Resources for obtaining, preparing food: Unknown
 Symptoms: Frequent urination, excessive thirst, hunger
 Anthropometric measurements
o Ht/wt: 70 in/ 177.8 cm and 165 lbs/ 75 kg
o BMI: 23.9 kg/m2 (normal)
o IBW= 166 lbs/ 75.5 kg (no malnutrition)
 5’=106#, 10”x6#=60#, 106#+60#= 166#
 165#/166#= .993 x 100= 99.3% (no malnutrition)
o % Weight loss= 1.33% (no degree of malnutrition)

Energy, protein and fluid needs

 Total Energy= 2128.5-2601.5 kcal/d


o Used Harris-Benedict formula to determine REE then multiplied by activity
(1.3) then plus or minus 10%
 Protein= 60-75 g/d
o Used non stressed state: 0.8-1.0 g PRO/kg
 Fluid= 2.6-3.0 L/d
o Used 35 ml/kg/day

Labs/tests- can indicate high or low, normal or abnormal

 Glycosylated hemoglobin= 9.4% (high)


 Serum albumin= 4.3 g/dL (normal)
 Serum Glucose: 180 mg/dL (fasting)
 Hgb: 14.7 g/dl (normal)
 Hct: 44% (normal)

Medications/supplements:
Nutrition Diagnosis- PES format

 Inadequate adherence to nutrition-related recommendations R/T consumption of


poor diet: high fat, sugar, sodium, and lack of fiber. Evidence by fasting blood
glucose (180mg/dL) and HbA (9.4%). Inadequate exercise and lack of blood glucose
monitoring.

Nutrition Intervention

 Meals and snacks


o Breakfast- Oatmeal with fresh fruit and glass of milk
o Lunch- Grilled chicken sandwich, salad, water
o Dinner- Grilled steak, baked potato, roasted vegetables
o Snacks- raw almonds, fat free yogurt, butter free popcorn
 Nutrition-related medication management
o Provide nutrition education for diabetics
o Exercise recommendations: refer to exercise physiologist

Goals
1) Monitor blood glucose twice per day
2) Exercise three times per week
3) Lower blood glucose and Glycosylated hemoglobin to normal levels
Nutrition Monitoring and Evaluation
1) Follow-up phone call in 2-3 days
2) Ask patient to keep a food log
3) Follow-up appointment in 3-4 weeks to re-asses blood work for serum glucose and HbA

Kerry Linne
3/14/17
N302L Case Studies
Nutrition Care Process (NCP): HDL
Nutrition Assessment

 Diagnosis: Cardiac muscle damage


 Nutrition- related PMH, treatments, surgeries: Coronary artery bypass graft
 Age, Gender: 54, Female
 Dietary intake: PO intake
 Symptoms: Recovering from surgery, smokes 2 packs/day, family history of heart
disease
 Anthropometric measurements
o Ht/wt: 64 in/ 162.56 cm and 148 lbs/ 67.3 kg
o BMI: 25.4 kg/m2 (overweight)
o IBW: 120 lbs/54.5 kg
 5’= 100#, 4” x 5#= 20#, 100+20= 120 lbs
 148#/120#=1.2 x 100= 123.3 % (obese)
o Adjusted body weight: 127 lbs/ 57.7 kg
o (148#-120#) x .25 + 120#= 127 lbs
Energy, protein and fluid needs based on Adjusted Body Weight

 Total Energy= 1586.1-1963.8 kcal/d


o Used Mifflin-St. Jeor formula to determine REE then multiply by activity
factor 1.3 and injury factor 1.05-1.3 (postoperative)
 Protein= 72.1- 86.6 g/d
o Used major surgery state for 1.25-1.5 g PRO/kg
 Fluid= 1.6-2.0 L/d
o Used 1 ml/kcal/day

Labs/tests- can indicate high or low, normal or abnormal

 AST: 76 U/L (high)


 ALT: 31 U/L (normal)
 LDH: 322 U/L (high)
 CPK: 268 U/L (high)
 Bilirubin total: 0.5 mg/dl (normal)
 Bilirubin direct: 0.1 mg/dl (normal
 HDL: 34 mg/dl (low)
 LDL: 156 mg/dl (high)
 Total Cholesterol: 240 mg/dl (high)
 Triglycerides: 250 mg/dl (high)

Nutrition Diagnosis- PES format

High fat diet R/T smoking, family history, and coronary artery bypass graft surgery AEB high
cholesterol (240 mg/dl), triglyceride (250 mg/dl), IBW% (123.3), AST (76 U/L), LDH (322 U/L), and
CPK (268 U/L)

Nutrition Intervention

 Meals and snacks


o Breakfast- Whole wheat toast with avocado and assorted fruit
o Lunch- Quinoa, roasted vegetables, and grilled shrimp salad
o Dinner- Baked sweet potato, grilled squash, and grilled chicken
o Snacks- Almonds, rice cakes with peanut butter, protein shake
 Nutrition-related medication management
o Refer to exercise physiologist for appropriate exercise routine
o Engage in cessation of smoking

Goals
1) Decrease body weight by 1-2 lbs/wk until IBW is reached or BMI is normal
2) Begin eating a healthy diet immediately
3) Quit smoking/reduce within 1 month
4) Begin regular exercise routine within 1-2 weeks

Nutrition Monitoring and Evaluation


1) Follow up phone call within 1 week
2) Keep dietary food log for at least 3 days
3) Get new blood work in 3-4 months to assess cholesterol, triglycerides, LDL, AST, LDH, and
CPK levels
4) Check in weekly to see how exercise routine is going
5) Check in weekly to see how cessation of smoking is going
Kerry Linne
2/12/17
N302L Case Studies
Nutrition Care Process (NCP): Hemoglobin/Hematocrit

Nutrition Assessment

 Diagnosis: Unknown
 Nutrition- related PMH, treatments, surgeries: Unknown
 Age, Gender: 22, female
 Dietary intake: PO intake
 Food preferences, allergies, intolerances: Vegetarian
 Exercise habits: None known
 Knowledge, readiness for change: Fatigued
 Functional/behavior behavior: Breastfeeding and stopped taking vitamins
 Resources for obtaining, preparing food: Unknown
 Symptoms: worn out/weakness
 Anthropometric measurements
o Ht/wt: 64 in/ 162.56 cm and 108 lbs/ 49.1 kg
o BMI: 18.6 kg/m2 (normal)
o IBW= 120 lbs (mild malnutrition)
 5’=100#, 4”x 5#= 20#, 100+20= 120 lbs
 108#/120#= .9 x 100= 90% (mild malnutrition)
o % Weight loss= 10% (mild degree of malnutrition)

Energy, protein and fluid needs

 Total Energy= 2607.1 kcal/d


o Used Harris-Benedict formula to determine REE then multiplied by activity
by 1.3 plus 500 kcals for lactation
 Protein= 51.3-61.1 g/d
o Used non-stressed state for .8-1.0g PRO/kg plus 12g for lactation
 Fluid= 2.6 L/d
o Used 1 ml per kcal

Labs/tests- can indicate high or low, normal or abnormal

 Hgb: 9.5 g/dL (low)


 Hct: 30% (low)

Medications/supplements: Prescribed but patient stopped taking them


Nutrition Diagnosis- PES format

 Inadequate energy and iron intake R/T lactation, vegetarian diet, and stopped
taking dietary supplements, AEB low value of Hgb 9.5 g/d, low value of Hct 30%,
and low IBW% of 90%

Nutrition Intervention

 Meals and snacks


o Breakfast- Vegetable egg frittata
o Lunch- Cold quinoa salad with broccoli, kale, sweet peppers, and legumes
o Dinner- Baked sweet potato, roasted vegetables, grilled tofu
o Snacks- almonds, vegetables and hummus, vegan protein shake
 Nutrition-related medication management
o Consume multi-vitamin and mineral supplementation as prescribed

Goals
1) Increase caloric intake to more than 95% of the total energy recommended
2) Weight gain of 1 pound per week until reaching IBW
3) Normalize Hgb and Hct values within 3 months
4) Eat more iron rich plant sources
Nutrition Monitoring and Evaluation
1) Follow up phone call in 3-7 days
2) Keep dietary food log for at least 3 days
3) Get new blood work in 3-4 weeks to reassess Hgb and Hct values
4) See if patient is still breast-feeding at follow up appointment

Kerry Linne
2/23/17
N302L Case Studies
Nutrition Care Process (NCP): Triglyceride
Nutrition Assessment

 Diagnosis: Type 2 diabetes mellitus


 Age, Gender: 37, female
 Dietary intake: PO intake
 Anthropometric measurements
o Ht/wt: 61 in/154.94 cm and 152 lbs/ 68.946 kg
o BMI: 28.8 kg/m2 (overweight)
o IBW= 105 lbs/ 47.7 kg
 5’=100#, 1”x 5#=5#, 100+5= 105lbs
 152#/105#= 1.44 x 100= 144.8 % (obese)
o Adjusted body weight: 116.78lbs/ 53.1 kg
 (152#-105#) x.25+105=116.8 lbs

Energy, protein and fluid needs

 Total Energy= 1593-1859 kcal/d


o 30-35 kcal/kg
 Protein= 42.5-53.1 g/d
o Used non-stressed state for .8-1.0g PRO/kg
 Fluid= 1.6-1.9 L/d
o Used 1ml per kcal

Labs/tests- can indicate high or low, normal or abnormal

 Serum albumin= 4.2 g/dl (normal)


 Glucose: 145 mg/dl (high)
 Hgb: 13.4 g/dl (normal)
 Hct: 41% (normal)
 Triglyceride: 250 mg/dl (high)

Nutrition Diagnosis- PES format

 Overweight status R/T preference high fat diet, AEB high blood glucose (145
mg/dl), high triglycerides (250 mg/dl), BMI 28.8 kg/m2, and %IBW 144.8%.

Nutrition Intervention
 Meals and snacks
o Breakfast- Whole wheat toast with avocado, non-fat yogurt, fresh berries
o Lunch- Caesar salad with grilled salmon
o Dinner- Baked potato, grilled vegetables, and roasted chicken
o Snacks- Rice cakes, almonds, avoid chips, candy, soda
 Nutrition-related medication management
o Refer to exercise physiologist for appropriate exercise routine
o Refer to diabetes educator for blood monitoring

Goals
1) Decrease body weight by 1-2 lbs/wk until IBW is reached or BMI is normal
2) Normalize glucose and triglyceride values within 3-4 months
3) Begin regular exercise routine within 1-2 weeks
4) Lower kcal consumption within 1 week to recommended levels

Nutrition Monitoring and Evaluation


1) Follow up phone call within 1 week
2) Keep dietary food log for at least 3 days
3) Get new blood work in 3-4 months to assess blood glucose and triglyceride levels
4) Check in weekly to see how exercise routine is going