Case Number: 2

Case Title: Adult Type 2 Diabetes Mellitus

Semester: Fall 2021 Class: NUTR 438A Section: Merged Group: 5

Electronic Signatures are acceptable. By signing this page, students assume full responsibilities of all
contents as well as credit of this report. Students who do not sign this page will not receive any credit for
the report.

Group Member 1: Print: Scarlett Pedretti Signature: Scarlett Pedretti Date: 12/5/2021

Group Member 2: Print: Karla Williams Signature: Karla Williams Date: 12/5/2021

Group Member 3: Print: Edith Magana Signature: Edith Magana Date: 12/5/2021

Group Member 4: Print: Lily Case Signature: Lily Case Date: 12/5/2021

Group Member 5: Print: Delaney DeSantis Signature: Delaney DeSantis Date: 12/5/2021

Brief Description of the Case

Patient M.F., a 56-year-old Latina female, was newly diagnosed with uncontrolled type 2 DM
and HHS. She has a history of hypertension, hyperlipidemia, and GD. She was admitted to the
ED with severe hyperglycemia and dehydration. Has a paternal history of HTN and CAD, while
her maternal history is unknown. Was prescribed and is taking Dyazide @ 1x/day and Lipitor
1x/day as well.

Updated 10/2017, 1/2018, 02/2019, 02/2021 LW

 Nutrition Care Process Worksheet

Step One: Nutrition Assessment

Nutrition Assessment involves the following five subcategories of information being collected, verified
and interpreted.

Food/Nutrition-Related Anthropometric Biochemical data, Nutrition-related Client History

History Measurements medical tests, and Physical Findings
procedures
Food and nutrient intake, Height, weight, body Laboratory data, Findings from a Current and past
food and nutrient mass index (BMI), (e.g., electrolytes, nutrition-focused information related
administration, medication growth pattern glucose, and lipid physical exam, to personal,
and indices/percentile panel) and tests interview, or the medical, family, and
complementary/alternative ranks, and weight (e.g., gastric medical record social history.
medicine use, history. emptying time, including muscle and
knowledge/beliefs/attitude resting metabolic subcutaneous fat, oral
s, behavior, food and supply rate). health,
availability, physical activity suck/swallow/breathe
and function, ability, appetite, and
nutrition-related affect.
patient/client-centered
measures.

1. Food/Nutrition-Related History

Consider: Patient’s/client’s appetite, food and nutrient intake, nutrition knowledge and beliefs; physical
activity habits; food availability; nutrient needs (measured, calculated, or estimated from a
formula/equation)

- Consumes 3 to 4 alcoholic beverages per week

- No physical activity habits
- Patient was dehydrated upon being admitted to the hospital and has been “feeling dry” for the past
two months
- Patient doesn’t follow any specific diet
- No education or previous history relating to diabetes or weight management
- Tries to avoid high-cholesterol foods, high-sugar desserts, and adding salt to her foods
- Usually eats breakfast at home
- Has been eating lunch at fast-food restaurants for the past several months
- Weekday dinners typically consist of Hispanic dishes. On the weekend, she goes out to dinner with her
family
- Enjoys eating Chinese food, pizza, fried chicken, or buffets when going out to eat

Comparative Standards
ESTIMATED NUTRITIONAL NEEDS: include energy, protein, CHO, fat, fiber, vitamins, minerals, H2O and
reference or basis for this estimate

Updated 10/2017, 1/2018, 02/2019, 02/2021 LW

Energy: Mifflin St. Jeor - REE = (9.99 X weight in kg) + (6.25 X height in cm) – (4.92 X age) – 161 * AF
REE = (9.99 x 86.18 kg) + (6.25 x 165.1 cm) - (4.92 x 56) -161 x 1.3
REE = 860.9 + 1,031.9 -275.5 - 161 x 1.3 (AF)
REE = 1,893 kcals

Protein: 25% x 1,893 = 473/4 = 118 grams. 10 exchanges of lean meat = 70 grams of protein. 3
exchanges of fat-free milk = 24 grams of protein. 5 exchanges of non-starchy vegetables = 10 grams of
protein. 5 exchanges of starches = 15 grams of protein. 119 grams of protein total.

CHO, fiber (type, amount, distribution, if applicable): 45% x 1,893 = 852/4 = 213 grams. 3 exchanges of
fat-free milk = 36 grams of CHO. 4 exchanges of fruit = 60 grams of CHO. 5 exchanges of non-starchy
vegetables = 25 grams of CHO. 5 exchanges of starches = 75 grams of CHO. 1 exchange of other CHO = 15
grams of CHO. 211 grams of CHO total.

Fat (type and amount, if applicable): 30% x 1,893 = 568/9 = 63 grams. 10 exchanges of lean meat = 30
grams of fat. 3 exchanges of fat-free milk = 3 grams of fat. 5 exchanges of starches = 5 grams of fat. 5
exchanges of fats = 25 grams of fat. 63 grams of fat total.

Vitamins and minerals (if applicable): Daily multivitamin to supplement nutrients missing from the diet

Please summarize the key dietary intake information (if available) in the table below. Please be selective.

This pt/ client Expected, normal, or reference value

High energy intake (3,048 kcals/day) 1,893 kcals/day
High carbohydrate intake (369 g/day) 211 g/day
High fat intake (96 g/day) 63 g/day
Slightly high protein intake (132 g/day) 119 g/day
Low fluid intake 2000-2500 mL/day

Interpretation and/or Comments on impacts of nutrition care (Note: Do not just paraphrase the
information)
Based on reported food/nutrition-related history, Mrs. F has little to no knowledge on nutrition and the
related health implications of malnutrition as they relate to her diseases. Additionally, she doesn’t
participate in any form of physical activity. Proper nutrition care could improve her overall quality of life
as well as the symptoms associated with T2DM, HHS, HTN, hyperlipidemia, and dehydration. A diet that
is rich in healthy fats, fruits, vegetables, whole grains, and lean protein sources, such as the
Mediterranean diet, would be most beneficial with the presence of T2DM and HTN that she has been
diagnosed with. Mrs. F’s current energy and macronutrient intake puts her at risk to worsen her current
and previously diagnosed illnesses. With the right nutrition care, she could gain control and be able to
reasonably manage these health concerns.

2. Biochemical data, Medical Tests and Procedures

This pt/client Expected or normal value

Serum glucose: 655 mg/dL Serum glucose: 70-130 mg/dL
BP: 150/88 mm Hg BP: <120/80 mm Hg
Resp Rate: 26 Resp Rate: 12-20 breaths/min

Updated 10/2017, 1/2018, 02/2019, 02/2021 LW

 Sodium: 132 mEq/L Sodium: 136-145 mEq/L
BUN: 31 mg/dL BUN: 6-20 mg/dL
Creatinine: 1.9 mg/dL Creatinine: 0.6-1.1 mg/dL
eGFR, non-AA: 39 mL/min/1.73m2 eGFR, non-AA: >60 mL/min/1.73m2
Glucose: 855 mg/dL Glucose: 70-99 mg/dL
Phosphate, inorganic: 1.8 mg/dL Phosphate, inorganic: 2.2-4.6 mg/dL
Anion gap: 6 mmol/L Anion gap: 10-20 mmol/L
Osmolality: 322.6 mmol/kg/H2O Osmolality: 275-295 mmol/kg/H2O
Cholesterol: 210 mg/dL Cholesterol: <200 mg/dL
VLDL: 37 mg/dL VLDL: 7-32 mg/dL
LDL: 140 mg/dL LDL: <130 mg/dL
Triglycerides: 187 mg/dL Triglycerides: 35-150 mg/dL
HbA1c: 9.5% HbA1c: <5.7%
WBC: 13.5 x103/mm3 WBC: 3.9-10.7 (x103/mm3)
Hct: 57% Hct: 37-47%

Interpretation and/or Comments on impacts of nutrition care (Note: Do not just paraphrase the
information).
Mrs. F's focus of care should be on her high blood pressure, blood glucose, triglycerides, and cholesterol
as they are related to her hypertension, hyperlipidemia, hyperglycemia, and type 2 DM. Weight
management should be the priority. All of these can be associated with her current diet and lifestyle.

3. Anthropometric Measurements

Consider: Weight, height, BMI, weight change, rate of weight change, growth percentiles (pediatric
pts), desirable or usual body weight, other anthropometric measures as appropriate (waist
circumference, skinfolds, body composition measures, etc.). Please remember to include appropriate
units of different measures.

This pt/client Expected or normal value

- Height: 5’5” A BMI of 18.5 to 25 is categorized in the normal

- Weight: 190 lbs.
- BMI: 31.6, obese
-IBW (Ideal body weight): 126 lbs.
- ABW (Adjusted body weight): 151 lbs.
range, whereas 30 or greater is considered
obese. Ideal body weight for a female that is
5’5” and 190 lbs., is 126 lbs. For non-pregnant
women, waist circumference should fall at or
below 35”, although this measurement isn’t
given.

Interpretation and/or Comments on impacts of nutrition care (Note: Do not just paraphrase the
information).
Currently, Mrs. F is considered obese based on her BMI, which can worsen T2DM and HTN. Proper
nutrition care and adherence would significantly enable Mrs. F to move towards an ideal body
weight (IBW) for her age and height and gain control of her newly diagnosed uncontrolled T2DM and
HHS, as well as improve her documented history of hyperlipidemia and hypertension. Working
towards an IBW through adequate nutrition care and education would also effectively lower her
serum glucose levels and reduce overall risk of mortality.

Updated 10/2017, 1/2018, 02/2019, 02/2021 LW

4. Nutrition-Focused Physical Findings

Consider: oral health, general physical appearance, skin integrity, muscle tone and/or subcutaneous
fat wasting, affect, and swallowing function. WHAT WOULD YOU OBSERVE, FEEL, SMELL, LISTEN FOR
IF YOU WERE MEETING THIS PATIENT IN PERSON?

This pt/ client Expected or normal

● Appearance: Obese, middle-aged female ● Not normal, she is obese

● Heart: Regular rate & rhythm ● Normal

● Eyes: PERRLA test done

● Normal
● Ears/Nose: Clear ● Normal
● Throat: Dry mucous membranes w/o ● Not normal, shows signs of dryness but
exudates or lesions no lesions.

● Neurological: Alert but previously ● Normal, but previously showed

drowsy with mild confusion drowsiness coupled with mild confusion

● Not normal, skin does not go back to its

● Skin: Warm and dry, but poor turgor
original state, it tents

● Chest & Lungs: Respirations are rapid- ● Normal

clear to auscultation and percussion

● Peripheral Vascular: Pulse 4+ bilaterally, ● Normal

warm, no edema

● Abdomen: Active bowel sounds x4; ● Not normal, there is a tenderness to her
tender, nondistended abdomen

Interpretation and/or Comments on impacts of nutrition care (Note: Do not just paraphrase the
information).
All nutrition-focused physical findings appear normal except the apparent signs of dehydration.
Dehydration is clearly seen in her throat and skin through dry mucous membranes and poor
turgor. She also has a tender abdomen which can be attributed to her experiencing bouts of
vomiting and not eating properly. After rehydration therapy, meeting the fluid requirement of
2,000-2,500 mL/day will improve signs of dehydration.

5. Client History

Consider: Medications and supplements and their nutrition implications, social history, personal
(age, occupation, family, education, etc.), medical/surgical/health history, substance habits.

Please feel free to add rows to the table as needed.

Updated 10/2017, 1/2018, 02/2019, 02/2021 LW

 Client History
56 year old female
Alcohol use: 3-4 drinks per week
Paternal history of HTN and CAD
No known maternal history
Current daily Lipitor (20 mg)
medication prescription
Current daily Dyazide (25 mg
hydrochlorothiazide and 375
mg triamterene) medication
prescription
History of gestational diabetes
History of HTN
History of hyperlipidemia
Catholic religious affiliation
English as limited, secondary language
Full-time occupation as laundromat
attendant
Lives with husband and two children
Latina/Latino ethnicity
Updated 10/2017, 1/2018, 02/2019, 02/2021 LW
Implications on Nutrition Care
Older adults are at a higher risk of being diagnosed with
T2DM
Alcohol consumption can worsen HTN. May also lead to
delayed hypoglycemia
Family history of HTN increases likelihood of patient
having HTN and T2DM
Without medical history of a 1st-degree relative, patient
might’ve been diagnosed sooner and might be at higher
risk for further illnesses
Grapefruit juice and alcohol should be limited or avoided
when taking Lipitor in order to prevent liver damage
Dyazide can deplete potassium and magnesium, so
supplementation of these minerals is recommended
after consulting with a RD.
Increases risk of T2DM
Increases risk of T2DM
Increases risk of T2DM and heart disease
Possible dietary restrictions that are followed on holy
days or periods
Possible language barrier could make it difficult for the
RD and patient to communicate effectively
Spending 9 hours daily at a sedentary job could
negatively impact plans of weight management
Having to purchase prepare meals meals for other family
members could cause difficulty in adhering to a dietary
intervention
May have certain dietary preferences based on ethnicity.
Persons of color are also at higher risk for T2DM, obesity,
and worsened HTN.
 Step Two: Nutrition Diagnosis

Intake Clinical Behavioral-Environmental

Actual problems related to intake of Nutritional findings/problems identified Nutritional findings/problems identified
energy, nutrients, fluids, bioactive that relate to medical or physical that relate to knowledge,
substances through oral diet or conditions attitudes/beliefs, physical environment,
nutrition support access to food, or food safety

1. Fill out the table below following the instructions. Please feel free to add lines to the table as
needed.

a. Identify potential nutrition issues

Based on Nutrition Assessment, please come up with a laundry list of ALL potential nutrition issues.
You can use your own words for now. What makes you think each of the potential nutrition issues
may exist (you can get the information from Nutrition Assessment)
b. Identify Nutrition Problems
Use standard language in the latest eNCPT, create a list of Nutrition Problems that corresponds to
the list of nutrition issues. Just a reminder, nutrition problems are classified into three domains (see
table above)
c. Determine Causes of Nutrition Problems
What do you think are the causes of each nutrition problem? You should be able to use information
from Nutrition Assessment to determine this. The Etiology Matrix is very helpful in this step.

Please feel free to add rows to each domain in the table as needed.

Potential Nutrition Issues What data from Nutrition Etiology

(can use your own word) Nutrition Assessment
makes you think this
issue may exist?
(get information from
Nutrition Assessment)
Intake Domain
eg. too much calorie intake eg. 24hr recall: 2600 Kcal vs eg. Excessive
needs of 2000 Kcal
Hyperlipidemia/High Usual intake of fast
cholesterol intake food/eating out.
Polyuria/Polydipsia Physical assessment:
Throat: Dry mucous
membranes & skin: poor
turgor
Problems (Use the Matrix as
(Use eNCPT) necessary, can use
free text or
standard language)
eg. Overconsumption
energy intake of high fat foods (you
would know this from
Nutrition
Assessment)
Excessive Fat Overconsumption of
intake high fat and high
cholesterol foods.
Inadequate fluid Disease: Type 2 DM
intake Physically unable to
consume liquids/keep
liquids down.
Continuous vomiting.

Updated 10/2017, 1/2018, 02/2019, 02/2021 LW

Glucose of 855 mg/dL Admitted with Excessive undesirable food
hyperglycemia carbohydrate choices
intake.
Clinical Domain
Very little variety in food, not Per recall- lack of food Undesirable food Overconsumption of
that many healthy choices variety, consumption of intake processed foods, and
highly processed foods. limited variety of
Labs: LDL 140 mg/dL fruits and vegetables
(<130), Cholesterol 210
mg/dL(<200)
Overweight/obese BMI 31.6 Excessive energy Lack of behavior
intake change of diet for
type 2 DM.
Behavioral-Environmental
Domain
Unspecified food amount in 24 hr recall: no clear Self monitoring Food and nutrition
24 hr recall amount of food eaten deficit knowledge deficit
Same foods for several 24 hr recall that is the Food and Cultural practice that
months and no clear variety same for several months nutrition related affect ability to
of fruits or vegetables and lacks variety knowledge deficit learn/apply
information

2. Using approved language, write the nutrition diagnosis as a PES statement.

Note: there may be many PES statements appropriate for one pt/client. Please write down two most
relevant and important PES statements below. These PES statements should drive your intervention later.
By default, nutrition problems in the first PES statement will receive the highest priority in Nutrition
Intervention.

PES Statement 1
Problem Excessive CHO intake R/T
Etiology Uncontrolled type 2 diabetes and food and nutrition AEB
knowledge deficit
Sign and Symptoms Severe blood glucose of 855 mg/dL (should be 70-99
mg/dL) and diet history per 24 hr recall of 3,048 kcal/daily
intake (should be 1,742 kcal/daily).
PES Statement 2
Problem Altered Nutrition-Related Laboratory Values R/T
Etiology Hyperglycemic Hyperosmolar Syndrome AEB
Sign and Symptoms Elevated BUN level of 31 mg/dL (should be 6-20 mg/dL),
HbA1c of 9.5% (should be <5.7%), and uncontrolled glucose
levels of 855 mg/dL (should be 70-99 mg/dL).

Updated 10/2017, 1/2018, 02/2019, 02/2021 LW

 Step Three: Nutrition Intervention
Food and/or Nutrition Education
nutrient delivery (E)
(ND)
Individualized Formal process to instruct
approach for food or train patients/clients in
/nutrient provision. a skill or to impart
knowledge to help
patients/clients voluntarily
manage or modify food,
nutrition and physical
activity choices and
behavior to maintain or
improve health.
Nutrition Counseling (C)
A supportive process,
characterized by a
collaborative
counselor–patient/client
relationship to establish food,
nutrition and physical activity
priorities, goals, and
individualized action plans
that acknowledge and foster
responsibility for self-care to
treat an existing condition
and promote health.
Coordination of
Nutrition Care (RC)
Consultation with, referral
to, or coordination of
nutrition care with other
providers, institutions, or
agencies that can assist in
treating or managing
nutrition-related
problems.

Please note:
1. Please do not limit yourself to the two nutrition problems you have written PES statements for.
You can and should address more nutrition problems you have listed in Nutrition Diagnosis.
2. There are four strategies of nutrition interventions (see table above). Food and/or Nutrient
Delivery is just one strategy.

1. Nutrition Prescription (Nutrition Rx):

Nutrition Prescription: The patient/client’s individual recommended dietary intake of energy

and/or selected foods or nutrients based on current reference standards and dietary
guidelines and the patient/client’s health and nutrition diagnosis (specify).

Specific diet (if applicable) Decreased carbohydrate diet, such as the

Mediterranean Diet
Energy goal (Kcal/day) 1,893 kcals/day

Protein goal (g/day) 118g/day

If there is any specific goal or restrictions, please list Decreased CHO diet
Decreased glucose levels
Decrease saturated fat

Updated 10/2017, 1/2018, 02/2019, 02/2021 LW

2. Please summarize the relevant evidence regarding nutrition therapy of the disease conditions.
Please indicate the source of the evidence (eg. the Nutrition Care Manual, Evidence Analysis Library,
the AHRQ or Cochrane databases, etc).

T2DM w/ uncontrolled HHS:

Studies have shown that there was improvement in quality of life, HbA1c levels, and medication
usage for adults with T2DM when an RDN implemented MNT. Studies showed mixed outcomes for adults
with T2DM regarding weight management and cholesterol levels when an RDN implemented MNT
(Diabetes type 1 and 2).
There is no one specific diet for T2DM, every individual is different. The following are general
recommendations based on research done with T2DM patients. Hypoglycemia may be caused by alcohol
intake without carbohydrates for patients on insulin. It is recommended to reduce sugar-sweetened
beverages because it can reduce blood glucose and lower calorie intake to maintain weight. A diet with
reduced fiber intake has been related to a slight reduction of A1c. A diet with reduced carbohydrate
intake has also shown a reduction of A1c and weight (Diabetes Mellitus Type 2).
TD2M patients need to be educated on how to look at nutrition labels and decipher whether or
not certain foods fit in their diet after talking to a registered dietitian. Since they need to be looking at
carbohydrates they should know that “ one carbohydrate serving is the amount of food with 15 g
carbohydrates”. They should talk to registered dietitians to determine their individual goal amount for
different nutrients, sodium, protein, fat, etc. Limiting saturated fat or trans fat is also important for heart
health (Diabetes Mellitus Type 2).
An RDN should determine whether blood glucose values can be adjusted through a food plan or
whether medication adjustments are needed The RDN should go over the goals set at initial visit during
every follow-up and talk about whether or not they were met and if they need to be adjusted. If the
client was unable to attain goals, discuss alternate solutions (Diabetes Mellitus Type 2l).
After implementing MNT, the RDN should ensure that other health care professionals, the
patient and their family and friends are on the same page so that the patient has the best opportunity
for reaching their goals (Diabetes type 1 and 2).

HTN:
Studies have shown that there was improvement in blood pressure for hypertension patients
when an RDN implemented MNT (Hypertension).
It is highly recommended to reduce sodium intake in the diet of HTN patients to 1,500 mg and
2,300 mg sodium per day. The RDN can help determine individualized limits for each patient. The DASH
diet plan helps reduce sodium intake but can also potentially benefit patients that are trying to maintain
a healthy weight limiting high-fat foods. It's important to focus on certain types of fat, reducing saturated
and trans fats that can harm heart health (Hypertension).
A nutritious diet, healthy weight and exercise are the elements of the recommended healthy
lifestyle to prevent hypertension and benefit the lives of those who have hypertension. But some risk
factors that are uncontrollable include age, ethnicity, and family history (Hypertension).
HTN patients that meet with an RDN will likely receive recommendations like, reduce sodium
intake, limit alcohol intake, reduce saturated fat and trans fat, increase fruit, vegetable, and whole grains
intake, and get regular physical activity in order to maintain a healthy body weight if not already
(Hypertension).

Updated 10/2017, 1/2018, 02/2019, 02/2021 LW

Hyperglycemia:
Diabetes patients can be diagnosed with hyperglycemia as a result of poor diet or inability to
take correct medication (Hyperglycemia). Ways to balance glycemic control may include a regular
physical activity, balanced diet, healthy portion sizes and avoidance of skipping meals.

3. Please fill out the table below regarding Nutrition Intervention. If you are recommending dietary
(diet order) changes, provide a one-day sample menu that meets your recommendations, and a
dietary analysis of the sample menu that proves that it meets your recommendations (Use Food
Processor software installed on computers in the FCS computer lab)

Please feel free to add rows to the table as necessary

Please note: the same nutrition problem can be tackled by different intervention tactics.

Nutrition Problems Describe the specific Standard Language Intervention Strategy

(see table in Nutrition intervention tactics
Diagnosis) you plan to
implement (use your
own words for now)
Excessive Fat intake What fats are good and
which are bad in excess
Inadequate fluid intake Slowly increase and
monitor water intake
throughout the day
Excessive energy intake Implement diet plan
using Mediterranean
diet as a guide to follow
Self-monitoring deficit Set up a meal plan for
client to follow
Undesirable food Increase consumption
choices of fruits
Undesirable food Increase consumption
choices of vegetables
Food and nutrition Provide information on
related knowledge what foods to avoid in
deficit excess
that corresponds to (ND, E, C, or RC)
the intervention
tactics (per eNCPT)
Content related E
nutrition education
Increased fluid diet ND
Decreased energy diet ND
Nutrition counseling C
based on self
monitoring strategy
Fruit modified diet ND
Vegetable modified diet ND
Nutrition counseling C
based on goal setting
strategy

Updated 10/2017, 1/2018, 02/2019, 02/2021 LW

 Step Four: Nutrition Monitoring and Evaluation

How will you know if your intervention is helping with the pt’s/client’s nutrition problem? Using
approved terminology, list indicators (signs and symptoms) you will re-evaluate. Monitoring and
Evaluation and Reference sheets are combined with Assessment Reference Sheets. (eNCPT).
Please feel free to add additional notes relevant to this case after each NCP term you deem appropriate
for this section.
Please delete any empty rows in each table.

Food/Nutrition-Relate Biochemical Data, Anthropometric Nutrition-Focused

d History Outcomes
Food and nutrient intake,
medication/herbal
supplement intake,
knowledge, beliefs, food
and supplies availability,
physical activity, nutrition
quality of life
Medical Tests, and
Procedure Outcomes
Lab data (e.g. electrolytes,
glucose) and tests (e.g.
gastric emptying time,
resting metabolic rate)
Measurement Physical Assessment
Outcomes Outcomes
Height, weight, body mass Physical appearance,
index (BMI), growth muscle and fat wasting,
pattern indices/percentile swallow function,
ranks, and weight history appetite, and affect

Please fill out the tables below and feel free to add more rows to accommodate more information, if
deemed appropriate.

Food/Nutrition-Related History Outcomes

Outcomes NCP Terminology Additional Notes if Applicable

1 Total energy intake
2 Total CHO intake
3 Total protein intake
4 Total fat intake
5 Total fiber intake
6 Total fluid intake
7 Types of food/meals
8 Areas of knowledge or skill
Recommended energy intake 1,893 kcals
Recommended CHO intake 213 g/day (45%)
Recommended protein intake 118 g/day (25%)
Recommended fat intake 63 g/day (30%)
Recommended fiber intake 25 g
Recommended fluid intake 2000-2500 mL/day
Monitor intake of current food types/meals
Monitor diet-related knowledge or skills

Anthropometric Measurement Outcomes

Outcomes NCP Terminology Additional Notes if Applicable

1 Height (AD-1.1.1) 5’5”
2 Weight (AD-1.1.4.2) 190 lbs.
3 Body Mass Index (BMI) (AD-1.1.5.1) 31.6, obese

Updated 10/2017, 1/2018, 02/2019, 02/2021 LW

 Biochemical Data, Medical Tests, and Procedure Outcomes

Outcomes NCP Terminology Additional Notes if Applicable

1 Blood Pressure, systolic, reported 150
(PD-1.1.21.3)
2 Blood pressure, diastolic, reported 88
(PD-1.1.21.4)
3 Glucose, casual (BD-1.5.1) 855 mg/dL
4 Cholesterol measured intake in 24 210 mg/dL
hours (FH-1.5.2.2)
5 Cholesterol LDL (BD-1.7.3) 140 mg/dL
6 Triglycerides, serum (BD-1.7.7) 187 mg/dL
7 Sodium measured intake in 24 hours 132 mEq/L
(FH-1.6.2.2)
8 Triglycerides, serum (BD-1.7.7) 187 mg/dL
9 BUN (BD-1.2.1) 31 mg/dL
10 Creatinine (BD-1.2.2) 1.9 mg/dL

Nutrition-Focused Physical Assessment Outcomes

Outcomes NCP Terminology Additional Notes if Applicable
1 Decreased skin turgor (PD-1.1.17.5) Warm and dry; poor turgor

2 Dry Skin (PD-1.1.17.8) Warm and dry; poor turgor

3 Temperature (PD-1.1.21.10) 100.5

4 Obese (PD-1.1.1.10) BMI=31.6

5 Blood Pressure, systolic, reported 150

(PD-1.1.21.3)
6 Blood pressure, diastolic, reported 88
(PD-1.1.21.4)
7 Respiratory rate (PD-1.1.21.9) 26

8 Pulse rate (PD-1.1.21.8) 150

9 Heart rate (PD-1.1.21.5) Regular rate and rhythm

10 Dry mucous membrane (PD-1.1.13.13) Location mouth/throat: dry mucous

membranes w/o exudates or lesions

11 Normal bowel sounds (PD-1.1.5.25) Active bowel sounds x4; tender, nondistended

Updated 10/2017, 1/2018, 02/2019, 02/2021 LW

 Documentation ADIME Notes
(No more than 1 page)

Nutrition Assessment
Chief Complaint: Abdominal pain, nausea, vomiting, and flu-like symptoms. Polyuria, polydipsia, and
“feeling dry” over the last 2 months.
Age: 56 Sex: F Ht: 5’5 Wt: 190lbs BMI: 31.6
Rx/Supplements: Dyazide once daily (25mg hydrochlorothiazide and 375mg triamterene), Lipitor 20mg
daily
Medical Hx: Gestational diabetes during last pregnancy; HTN; hyperlipidemia
Surgical Hx: C section
Allergies: N/A Wt Hx: N/A Physical Activity Hx: N/A
Estimated intake: 3,048 kcal/day
Comparative standards
Total Energy Estimated Needs: 1,893 kcal/day
Estimated Protein Needs: 119 g/day
Estimated Carbohydrate Needs: 211 g/day
Estimated Fat Needs: 63 g/day
Estimated Fluid Needs: 2000-2500 mL/day

Nutrition Diagnosis
PES Statements
1. Severe blood glucose of 855 mg/dL (should be 70-99 mg/dL) and diet history per 24 hr recall of
3,048 kcal/daily intake (should be 1,893 kcal/daily).
2. Elevated BUN level of 31 mg/dL (should be 6-20 mg/dL), HbA1c of 9.5% (should be <5.7%), and
uncontrolled glucose levels of 855 mg/dL (should be 70-99 mg/dL).

Nutrition Intervention

Nutrition Rx: 1,893 kcal/day, 119 g/day of PROTEIN, 211 g/day of CARBOHYDRATES, 63 g/day of FATS,
2000-2500 mL/day of FLUID needs

Intervention #1: Suggested Mediterranean Diet

Goal: Decreasing excessive carbohydrates intake from diet.
Intervention #2: Meals and Snacks: Limiting high saturated fat and sweets
Goal: Decreasing high saturated fats and overly sweet food snacks during meals and as snacks.

Nutrition Monitoring and Evaluation

- Monitor weight for decrease in BW to an IBW of 126 lbs.
- Monitor intake of sugar and complex carbohydrates to decrease HHS.
- Monitor intake of sodium so that it decreases blood pressure.
- Monitor blood glucose levels before every meal and before bed time.
- Keep a notebook/journal with blood glucose levels and the time it was taken.
- Monitor blood pressure at home with a portable blood pressure machine.
- Take blood pressure in the morning, afternoon and before bed to see how blood pressure reads
throughout the day and keep a record of it for changes.

Updated 10/2017, 1/2018, 02/2019, 02/2021 LW

 References Cited in this Worksheet (APA format)

1. Dietary guidelines for Americans, 2020-2025 - executive ... Dietary Guidelines for Americans.
(2020).https://www.dietaryguidelines.gov/sites/default/files/2020-12/DGA_2020-2025_Executiv
eSummary_English.pdf.
2. Diabetes Mellitus Type 2. (n.d.). Retrieved December 2021, from https://www.nutritioncarema
nual.org/topic.cfm?ncm_category_id=1&lv1=5517&lv2=274760&lv3=274761&ncm_toc_id=2747
61&ncm_heading=Nutrition+Care.
3. Diabetes type 1 and 2. (n.d.). Retrieved December 2021, from https://www.andeal.org/topic.cf
m?menu=5305.
4. Hyperglycemia. - nutrition care manual. (n.d.). Retrieved December 2021, from https://w
ww.nutritioncaremanual.org/topic.cfm?ncm_toc_id=272429.
5. Hypertension. - nutrition care manual. (n.d.). Retrieved December 2021, from https://www .nutri
tioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=272984&l
v2=8480&ncm_toc_id=8480&ncm_heading=Nutrition+Care#.
6. Hypertension. EAL. (n.d.). Retrieved December 2021, from https://www.andeal.org/topic.cfm?
menu=5285.
7. Track Nutrition & Count calories. Cronometer. (2020.). Retrieved December, 2021, from
https://cronometer.com/.

Updated 10/2017, 1/2018, 02/2019, 02/2021 LW

 Appendices

Appendix A. Dietary assessment: pre-intervention intake analysis by a software. Please include

the output of analysis that clearly indicates:
● Energy intake
● Macronutrient intake
● Micronutrient intake
● Distribution of different type of fats (usually a pie chart)

Appendix B. Nutrition Intervention: sample menu for one-day. Please list all items in each
eating/feeding event with quantity.

Appendix C. Analysis of the sample menu using software. Please include the output of analysis
that clearly indicates:
● Energy intake
● Macronutrient intake
● Micronutrient intake
● Distribution of different type of fats (usually a pie chart)
● Other key information specified in Nutrition Intervention

Updated 10/2017, 1/2018, 02/2019, 02/2021 LW

 Appendix A

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Updated 10/2017, 1/2018, 02/2019, 02/2021 LW
 Appendix B

Breakfast
● 1- 5 veggie omelet (spinach, mushrooms, tomatoes, onion, peppers)
● 1 cup of Coffee

Lunch
● 2 cups (16 oz) - Lentil soup
● 2 cups - Side Salad with the juice from 1 lemon wedge and 0.5 tbsp of olive
oil

Snack
● 1 - Whole-grain pita with 2 tbsp of hummus, approximately 1 cup of
chopped vegetables (broccoli and carrot), and half a cup of olives

Dinner
● 150g of Roasted Chicken
● 2 cups of cooked Zucchini with Mrs. Dash (salt-free seasoning)
● ½ cup of Farro with 1 ¼ cup of chopped spinach

Dessert
● 1 ½ cups of Mixed Berries
● 1 cup of Low-fat Greek vanilla yogurt

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 Appendix C

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Updated 10/2017, 1/2018, 02/2019, 02/2021 LW