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Nutrition Care Conference

Nutrition Care Conference. Manchester Manor By: Cassondra Hunter. Overview of Patient. Initials: A.C. Gender: Male Age: 87 Admitted on 7/11/13 Seen on 10/23/13 and 11/6/13. Psychosocial. Lives with his wife at home; reported he does most of the cooking and grocery shopping

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Nutrition Care Conference

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  1. Nutrition Care Conference Manchester Manor By: Cassondra Hunter

  2. Overview of Patient • Initials: A.C. • Gender: Male • Age: 87 • Admitted on 7/11/13 • Seen on 10/23/13 and 11/6/13

  3. Psychosocial • Lives with his wife at home; reported he does most of the cooking and grocery shopping • Never received Meals on Wheels or SNAP • White, non-Hispanic • Opted for DNR/DNI in an emergency • Was an investigator at Pratt & Whitney • Has a good attitude overall; was impatient toward the end

  4. Physical Signs • In a wheelchair • Glasses • Partial dentures • Skin, eyes, mouth, and hair were all in good condition

  5. Anthropometric Data • Height: 5 feet 7 inches • Weight (10/23/13): 126.5 lbs • BMI: 19.85 (normal, but on the low end & has had significant weight loss) • IBW: 148 lbs ± 10% • %IBW: 85.5% (mild malnutrition) • Clinical Data (taken 10/14/13): • BP- 110/58 • Temperature- 92.6°F

  6. Nutrition History • Likes: • Lobster, steak, shrimp, chocolate cake (eats it every night) • Dislikes: • Ensure, fortified pudding (provided by MM), and chicken • Meal Pattern: • Breakfast, Lunch, Dinner, Snack • Appetite: • Currently taking Megace, so his appetite is very good. Now eats 100% of his meals. Prior to medication, he only consumed 60-85% of his meals.

  7. Medical History • Stage 3 Pressure Ulcer (sacral wound) • GI Bleeding • Pneumonia, SOB worsening • COPD • Unspecified Essential HTN • Clostridium difficile infection colitis • UTI, site not specified • Pulmonary Embolism • Depression

  8. 2 Chief Diagnoses • 1st = Severe Weight loss

  9. A.C. had a 19.9% loss of weight in 4 months severe wt loss Summary of Weight Loss

  10. Chief Diagnosis (cont.) • 2nd = Stage 3 Pressure Ulcer

  11. Stage 3 Pressure Ulcer

  12. Medications • FeSO4- hematinic, antianemic mineral supplement • A.C. lost iron from blood loss with GI bleed & has protein malnutrition • Megace- appetite stimulant • Symptoms: nausea, dyspepsia • Coumadin- anticoagulant • Symptoms: taste changes, N/V, cramps, diarrhea • Metoprolol- antihypertensive • Symptoms: dry mouth, N/V, diarrhea, dyspepsia, constipation, flatulence

  13. Medications (cont.) • Remeron- antidepressant • Symptoms: dry mouth, N/V, abdominal pain, constipation • Pantoprazole- anti-GERD, antisecretory • Symptoms: abdominal pain, nausea, diarrhea • Sertraline- antidepressant • Symptoms: dry mouth, N/V, dyspepsia, diarrhea, constipation

  14. Protein Supplements • Mighty Shakes • Magic Cup • Super Cereal • Prosource

  15. Biochemical Data • Chloride • Maintains body water & acid/base balance • Normal Range: 98-106 mmol/L • Patient’s Results: 110 mmol/L • High value can indicate renal failure, use of potassium-sparing diuretics, acidosis, cell damage, dehydration, diabetes out of control, addison’s disease, SIADH, hypoaldosteronism, sepsis, shock, or pneumonia

  16. Biochemical Data (cont.) • BUN (Blood Urea Nitrogen) • Detoxified product of protein metabolism & indicates recent protein intake • Normal Range: 10-20 mg/dL • Patient’s Results: 36 mg/dL • High value can indicate dehydration, increased protein intake, renal failure/insufficiency, increased catabolism of protein D/T infection, tumors, starvation, stress, trauma, MI, DM, increased age, bleeding ulcers, GI hemorrhage, pneumonia, multiple myeloma, pancreatitis, CHF, and renal vein thrombosis.

  17. Biochemical Data (cont.) • Na+ 138 mmol/L • K+ 4.8 mol/L • HCO3- 22 mmol/L • Creatinine 0.8 mg/dL • Glucose 73 mg/dL *All of these lab values fell within normal ranges, therefore, were not concerning

  18. Medical Nutrition Therapy • Increase calorie, protein, and fluid intake • Calorie: 35-40 kcals/kg • 40 kcal x 57.5 kg= 2,300 • Protein: 1.5 g/kg • 1.5 gx 57.5 kg= 86 g • Fluid: 1 mL/kcal • 1 mLx 2,300 kcal= 2,300 mL (~10c) • Zinc, Vitamin C, & protein supplements for wound healing • Protein supplements: magic cup, super cereal, & prosource • Multivitamin supplement to increase mineral levels

  19. Diet Order • Cardiac Diet, Regular Consistency • A regular consistency diet allows the pt to consume all foods in their naturally prepared state, with no mechanical modifications made to them • The cardiac diet includes limiting sodium, saturated, trans, and total fats in the diet as well as cholesterol. Additionally, the cardiac diet encourages eating more omega-3 fats, fiber, and plant based meals

  20. Nutritional Needs • Calories: 2,300 kcal • 40 kcal/kg • Carbohydrates: 316 g/day • 55% CHO • Protein: 1.5 g/kg • 86 g/day • 15% Protein • Fat: 77 g/day • 30% Fat • Fluid: 2,300 mL (~10c) • 1 mL/kcal

  21. Pertinent Vitamins & Minerals • Zinc • 200 mg/day • Protein structure, immune function, & wound healing • Vitamin C • 1000 mg/day • Wound healing, immune function, & collagen synthesis • Multivitamin supplement • Iron, B Vitamins, Vitamin A ,and Vitamin E • Increase mineral levels & increase healing

  22. Sample Menu Lunch Breakfast Mid-morning Snack 1/2c canned peaches 1/4c low sodium cottage cheese • Salad- 1c lettuce, 2hardboiled eggs, 2tbsp reduced fat Italian dressing, 1/4c tomatoes, 1/4c cucumbers • 1 banana • 2/3c whole wheat pasta • 1/2c tomato sauce • 1c super cereal w/ 1c skim milk • 1/2c cranberry juice • 1 apple • 16 fl oz coffee w/ 2tbsp half and half + 1tbsp sugar Afternoon Snack • 12 saltines • 1c grapes • 1 Magic Cup (provided by MM)

  23. Sample Menu (cont.) Dinner Evening Snack 2" chocolate cake 1 Mighty Shake (provided by MM) • 3oz shrimp, stir fry with 1/2c broccoli, 1/2c carrots, 1/2c green beans • 2/3c brown rice Total calories: 2,275 kcal Total Protein: 117 g

  24. Nutrition Care Process • Diagnosis: • Unintended weight loss • Inadequate protein intake • PES statements: • Unintended weight loss related to decreased appetite/intake not meeting needs, as evidenced by 19.9% weight loss over four months (severe), 158 lbs to 126.5 lbs. • Inadequate protein intake related to increased protein needs as evidenced by stage 3 pressure ulcer on sacrum.

  25. Nutrition Care Process • Intervention • Increase weight • Patient will consume 85-100% of each meal (nurse to monitor) • Patient will continue to take Megacemedication to stimulate appetite • Increase protein intake • Patient will consume protein supplements including mighty shakes, super cereal, and magic cup • Promote wound healing • Patient will supplement with Vitamin C, Zinc, and multivitamin daily • Monitoring & Evaluation • Follow up with tolerance of supplements • Continue to monitor weight closely by taking weekly weights • RD to request albumin, BUN, Hgb &Hct labs

  26. Works Cited: • Mahan, L. Kathleen., and Sylvia Escott-Stump. Krause's Food, Nutrition, & Diet Therapy. Philadelphia: Saunders, 2004. Print. • Pronsky, Zaneta M., and Jeanne P. Crowe. Food Medication Interactions. Birchrunville, Penn.: Food-Medication Interactions, 2012. Print. • "Zinc." — QuickFacts. N.p., n.d. Web. 25 Nov. 2013. <http://ods.od.nih.gov/factsheets/Zinc-QuickFacts/>. • "MedlinePlus - Health Information from the National Library of Medicine." U.S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 24 Nov. 2013. <http://www.nlm.nih.gov/medlineplus/>. • Mayo Clinic. Mayo Foundation for Medical Education and Research, n.d. Web. 24 Nov. 2013. <http://www.mayoclinic.com/>. • "NCM Nutrition Care Manual Eat Right." Public Home Page. N.p., n.d. Web. 25 Nov. 2013. http://nutritioncaremanual.org/ • “Stages of Pressure Ulcers.” [Image] https://www.google.com/search?hl=en&site=imghp&tbm=isch&source=hp&biw=1008&bih=491&q=stage+3+pressure+ulcer&oq=stage+3+pressure+ulcer&gs_l=img.3..0l4j0i5j0i24l5.997.5062.0.5178.22.17.0.5.5.0.129.1498.13j4.17.0....0...1ac.1.32.img..0.22.1520.MjZtSNemdEI#facrc=_&imgdii=_&imgrc=DXivIyM8JbWl0M%3A%3B8iDyEs45F-7Y5M%3Bhttp%253A%252F%252Fimg.webmd.com%252Fdtmcms%252Flive%252Fwebmd%252Fconsumer_assets%252Fsite_images%252Fmedia%252Fmedical%252Fhw%252Fh9991533_002.jpg%3Bhttp%253A%252F%252Fwww.webmd.com%252Fskin-problems-and-treatments%252Ffour-stages-of-pressure-sores%3B460%3B300

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