Fisher 1

Joel Fisher
DIE 3213 -NUTRITION THERAPY 1
Case Study One
Janine R. Dray, MSH, RD, LD/N
10-01-2014

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QUESTIONS
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)
2.2 lbs. per kilogram

12 inches = 1 ft.
1 inch = 2.54 cm
1 cup = 0.24 L

145 lbs. 2.2 lbs. = 65.9 kg

52 = 62 inches
62 in 2.54 cm = 157.5 cm
0.01 m = 1 cm1(pg.1047)

BMI Weight (kg) Height (m2)

UBW% = 145 lbs./155 lbs. 100% = 93.5% = 6.5% loss

Marian is said to have a severe weight loss due to
the fact she has lost greater than 5% of her weight
in one month.

157.5 cm 0.01 m = 1.58 m

IBW% = 100lbs for first 5 ft. and 5 lbs. per

inch over 5ft. = 110 lbs.
145lbs/110lbs 100% = 132%
Marian is 35 lbs. over her ideal body weight.

65.9 kg (1.58)2 = 26.4

Based on the standards of BMI, Marian is considered to be overweight. This puts her at a higher
risk for cardiovascular disease and diabetes.1(pg.166)
2. Calculate her nutritional requirements (calories, protein, and fluid) and compare her
current intake to her needs. (5 points)
Nutritional Requirements
Calories Mifflin-St. Jeor 10 (65.9kg) + 6.25 (157.5cm) -5 (79) -161 = 1087 calories
Protein 0.1g/kg = 0.1g x 65.9kg = 65.9 g1(pg.24)
Fluid RDA method 1 mL per 1 kcal = 1.1 L2

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Actual Intake
Calories 1631 calories
Protein 104 g
Fluid 4 cups3
The use of the USDA Super Tracker and Marians usual intake information, it was shown
that she consumes 1631 calories, 104 grams of protein, and four cups of fluid. The use of the
Mifflin-St. Jeor equation, the protein consumption equation, and the RDA method for fluid
intake were used and compared to Marians actual intake. The comparison showed Marian
consumed approximately 544 calories too many, 34.5 grams of protein too many, and
approximately one-half a cup too little of fluids.1,2,3
3. Are any major food groups and nutrients obviously missing from her diet? Explain your
answer. (5 points)
The food groups that are missing or low are dairy and fruit. Marian was one cup short
on dairy and one cup short on fruit. These values are based on needing three cups of dairy and
one and one-half cups of fruit daily.3
The nutrients Marian are low in include calcium, potassium, magnesium, zinc, vitamin a,
vitamin c, vitamin e, vitamin k. The chart below shows a comparison between the target
amount and actual amount for the vitamins and minerals.
Nutrient
Calcium
Potassium
Magnesium
Zinc
Vitamin A
Vitamin C
Vitamin E
Vitamin K

Target
1200 mg
4700 mg
320 mg
8 mg
700 ug RAE
75 mg
15 mg
90 ug

Actual
772 mg
2881 mg
266 mg
6 mg
563 ug RAE
50 mg
8 mg
35 ug

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4. Do you think she could be experiencing any drugnutrient interactions? If so, what dietary
suggestions would you make? (5 points)
I believe Marian is experiencing a few different drug-nutrient interactions. The first
medication, bumex, is shown to decrease blood/serum potassium levels and increase
blood/serum glucose levels.4(pg.114) The next drug, kaopectate, is shown to decrease
blood/serum potassium levels.4(pg.58) The next drug, mineral oil, is shown to reduce the
absorption of potassium.4(pg.218) The last drug, trilisate, is shown to increase blood/serum levels of
potassium and lower blood/serum levels of glucose.4(pg.170)

The drug interactions with potassium and glucose levels were highlighted since these
values were out of the normal range. Marians potassium level was measured at 3.2 mEq/L
which is below the normal range of 3.6 - 5 mEq/L. Her glucose level was measured at 108 mg/dL
which is above the normal range of 70-99 mg/dL.1(pg.194)
It is important to note that trilisate can also cause depression, increase the risk for
cardiovascular problems, and decrease appetite.4(pg.170) This may help explain part of the reason
Marian feels depressed, is not eating well, and why she had a CVA five years ago. She is also
taking an anti-diarrheal, kaopectate, and a laxative, mineral oil, which can have contradictory
effects.
Marian could consume bananas to increase her potassium intake. She could also
increase her dietary fiber intake to both improve regularity and help bring down her
blood/serum glucose levels. She might try eating beans, peas, and bran cereal.5
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)

The patients albumin level was 3.2 mg/dL which is below the normal range of 3.5-5
mg/dL. The data provided by her usual dietary intake suggested her vitamin A and zinc
consumptions were under the estimated average requirements. A deficiency in vitamin A, zinc,
and iron can lead to lower serum level. Serum levels can also be decreased from short-term
protein deficiency, energy deficiency, and when protein is secreted by blood vessels due to
trauma.1(pg.198)
The patients prealbumin level was 11 mg/dL, which is above the malnutrition level of
under 8 mg/dL but below the normal range of 15-36 mg/dL. Factors that contribute to lower
prealbumin levels include: stress response, liver disease, protein-losing enteropathy, nephrotic
syndrome, hemodilution, and acute zinc deficiency.1(pg.1083)
Albumin levels may increase when a patient experiences severe dehydration or eats a
high protein diet. Prealbumin levels may be elevated during pregnancy and nephrotic syndrome
(proteinuria and hypoproteinemia are common).1(pg.194)

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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)
Marian is a 79 year old, 52, 145 pound woman that has a BMI of 26.4. This data states
she is overweight and at a higher risk of cardiovascular disease and diabetes. She is 132% of her
ideal body weight but has also experienced a 6.5% drop from her usual body weight in one
month. She has experienced severe weight loss which can be contributed to her limited
appetite, chronic diarrhea, and reported depression. Marians blood/serum potassium level is
low at 3.2 mEq/L which is outside of the normal range of 3.6 5 mEq/L. This can be attributed
to her intake of bumex, kaopectate, and mineral oil. Her blood/serum level of glucose is a little
high at 108 mg/dL which is outside of the normal range of 70-99 mg/L. This can be attributed to
her intake of bumex. Marians pre-albumin level was low at 11 mg/dL which is outside the
normal range of 15-36 mg/dL. This can be attributed to a zinc deficiency related to her diet. Her
albumin level was also low at 3.2 mg/dL which is outside the normal range of 3.5-5 mg/dL. This
can be attributed to her deficiency in both zinc and vitamin a.
Marians overall nutrition assessment determined she needs to make a few changes.
She is currently consuming 544 calories too many, 34.5 grams of protein too many, and
approximately one-half a cup too little of fluids. She also needs increase her intake of both fruit
and dairy by one cup. She also needs to increase her intake of a few key vitamins and minerals
as shown below.
Nutrient
Calcium
Potassium
Magnesium
Zinc
Vitamin A
Vitamin C
Vitamin E
Vitamin K

Target
1200 mg
4700 mg
320 mg
8 mg
700 ug RAE
75 mg
15 mg
90 ug

Actual
772 mg
2881 mg
266 mg
6 mg
563 ug RAE
50 mg
8 mg
35 ug

Marian can increase her intake of these vitamins and minerals by consuming the foods
as follows.
Potassium: supplement or bananas
Zinc: supplement or lentils/beans
Vitamin A: supplement carrots, sweet potato
Calcium: supplement or milk/cheese
Magnesium: supplement - beans
Vitamin C: supplement - papaya
Vitamin E: supplement wheat germ oil
Vitamin K: supplement kale

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7. Write a PES statement based on the nutritional assessment data available.

(5 points)
Problem (Nutrition Diagnostic Label) Unintended weight loss
Etiology as related to limited oral intake
Signs and symptoms as evidenced by a 6.5% drop from usual body weight over one month.
Unintended weight loss as related to limited oral intake as evidenced by a 6.5% drop from usual
body weight over one month.1(pg.1052)

8. What dietary and social changes would you suggest to improve her nutritional intake? (5
points)
I would suggest Marian start eating with a relative or in a social group setting to improve
her overall mood. Time spent with other individuals could help with Marians depression and
encourage her to begin eating more than she currently is. I would also encourage to drink onehalf a cup more of fluids, one cup more of dairy, and have one cup more of fruit. I would also
suggest the bring-up her values for her vitamins and minerals as follows:
Potassium: supplement or bananas
Zinc: supplement or lentils/beans
Vitamin A: supplement carrots, sweet potato
Calcium: supplement or milk/cheese
Magnesium: supplement - beans
Vitamin C: supplement - papaya
Vitamin E: supplement wheat germ oil
Vitamin K: supplement kale
These suggestions could also be used to help fill in the gaps Marian has in fluids, dairy,
and fruit.5
9. What are your nutritional goals for her, and how would you monitor the effectiveness of
your interventions from question #8? (5 points)
Marians first goal would be to stop the severe weight loss she has faced in the previous
month. She can accomplish this task as outlined above. This task can be monitored by assessing
changes in her body weight as compared to her usual body weight. If the new plan is successful,
no further weight loss will be seen. Another goal for Marian would be to improve her lab values
by balancing her diet as noted above. This can be monitored by redoing her lab values in
successive weeks to determine if the intervention is working.

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10. Write a note documenting your assessment in SOAP format. (5 points)

S: Patient reports feeling of depression, bad teeth, and loss of appetite.
Patient reports typical diet as follows:
Breakfast
Corn flakes/whole milk and 2 tsp sugar
Black coffee
Lunch
Peanut butter/jelly sandwich
1 C canned tomato soup
C canned pears
Dinner
Fish
Buttered noodles
C green beans
1 C Whole Milk
O: Anthropometric data ( Height 52, weight 145 lbs, BMI 26.4, IBW% - 132%, UBW% - 6.5% loss)
Labs

PARAMETER
Sodium
Potassium
Chloride
Carbon dioxidie
BUN
Creatinine
Glucose
Hemoglobin
Hematocrit
Albumin
Prealbumin

VALUE
140 135-145 mEq/L
3.2 3.6-5mEq/L
103- 101-111 mEq/L
29 21-31 mEq/L
19 5-20 mg/dL
1.0 0.5 1.1mg/dL
normal
108 - 70-99mg/dL
normal
12.0 12-16 g/dL
38.1- 35-47%
3.2 3.5-5 mg/dL
11- 15 mg/dL 36
mg/dL

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Medications
Trilisate, Bumex, Kaopectate, and mineral oil.
A: Patient consumes approximately 544 calories too many, 34.5 grams of protein too many, and

approximately one-half a cup too little of fluids.

Patient is facing severe weight loss due to poor eating.
Patient is also low on dairy and fruit by one cup.
Patient is low on calcium, potassium, magnesium, zinc, vitamin a, vitamin c, vitamin e, vitamin
k.
Patients blood/serum glucose level is high.
Patients blood/serum levels of potassium, albumin, and pre albumin are low.
P: Patient encouraged to eat more balanced diet and increase intake to stop weight loss.
Patient advised to eat in social setting or with a relative to help depression.
Patient can correct lab values by taking a potassium supplement (or eating bananas), eating fiber bring
down the glucose level, taking a vitamin a supplement (or eating carrots), and taking a zinc supplement
(or eating beans).
Patients can increase other deficient vitamins/minerals by taking:

Potassium: supplement or bananas

Calcium: supplement or milk/cheese
Magnesium: supplement - beans
Vitamin C: supplement - papaya
Vitamin E: supplement wheat germ oil
Vitamin K: supplement kale1(pg.261)

References (AMA format)

1. Mahan LK, Escott-Stump S, Raymond JL et al. Krause's Food & the Nutrition Care
Process. Edition 13. St. Louis, Missouri. Elsevier Health Sciences; 2012.
2. Manual of Clinical Dietetics, 6th ed, American Dietetic Association, Chapter 1, Nutrition
Assessment of Adults, 2000, p. 33.
3. Nutrients report. SuperTracker Web site.
https://www.supertracker.usda.gov/Nutrientsreport.aspx. Updated 2014. Accessed
09/20, 2014.
4. Pronsky ZM, Sr. JP. Food Medication Interactions. Edition 17. Birchrunville, PA: FoodMedication Reactions; 2012.
5. Vitamin and minerals. National Institutes of Health Web site.
http://ods.od.nih.gov/search.aspx?zoom_query=vitamin. Updated 2014. Accessed
09/28, 2014.