Scenario 2:

A 62-year-old man is admitted to the hospital from the doctor’s office with altered mental status.
Past medical history reveals cirrhosis resulting from hepatitis C, esophageal varices, hepatic
encephalopathy, and ascites. The patient reports missing his doses of lactulose the two previous
days. Muscle wasting is noted in the form of squared shoulders, prominent clavicle, temporal
wasting, and thin extremities. He has 3% edema in his lower extremities and a protuberant
abdomen from ascites. His abnormal laboratory values on admission included elevated liver
function enzymes and total bilirubin, sodium 127 mEq/L, glucose 68 mg/dL. Nutritional data
include height, 177.8 cm; weight, 71.8 kg; ideal body weight, 75 kg; recent body weight range
due to fluid fluctuations, 63.6 kg to 90.9 kg.

Nutrition Diagnostic Statements?

1. Involuntary weight loss related to cirrhosis as evidenced by loss of dry body weight and physical signs of
malnutrition.

2. Altered laboratory values related to cirrhosis as evidenced by hyponatremia and hypoglycemia.

Interventions?

Initiate 2 g sodium diet with small, frequent meals.

Initiate commercial beverage twice daily.

Monitoring and Evaluation?

Monitor food and beverage intake.

Assess food and nutrition knowledge.

Assess adherence to prescribed diet.