1 / 31

Case Study

Explore a case study outlining a 50-year-old male with HIV and severe malnutrition, covering nutrition assessment, diagnosis, intervention, and monitoring. Learn about HIV background, prevalence, wasting syndrome, and the importance of nutrition in managing HIV. Discover the impact of HIV on the immune system, complications like wasting syndrome, and the role of nutrition in maintaining health.

curtischarles
Download Presentation

Case Study

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case Study Oluremi Famodu WVU Dietetic Intern

  2. Outline • The Patient • HIV (Background/Prevalence) • HIV and Wasting Syndrome • Nutrition and HIV • Nutrition Assessment of Patient • Diagnosis • Intervention • Monitoring and Evaluation

  3. Patient Demographics • 50 yo ♂ • 52.7 kg (115.9 pounds) • 5’11’’ (180.34 cm) • BMI 16.2 – Protein/Energy Malnutrition Grade II • Ideal Wt: 75.3 kg (165.7 pounds) • 70% IBW • Former smoker and drinker

  4. Patient Medical History Current Medical Hx • HIV positive • Possible Tuberculosis (TB) • >110 pound weight loss in 5 years • Cachexia (Wasting Syndrome) • Weakness • s/p PEG placement • Pancytopenia • Hyponatremia Past Medical Hx • HIV • PEG tube placement • Bilateral Hip replacement

  5. The Virus

  6. The Human Immunodeficiency Virus (HIV) • Zoonotic retrovirus (transfer between species: monkey  human) • Rapid or severe loss of CD4+ T lymphocytes • Lentivirus (slow replicating) • Causes Acquired Immunodeficiency Syndrome (AIDS) • Progressive failure of the immune system allowing life-threatening opportunistic infections and cancers to thrive • No cure…but it can be controlled! • Average life expectancy for untreated HIV= 10 years

  7. HIV Time Course

  8. HIV/AIDS Pandemic • Over one million people living with HIV/AIDS in the United States (CDC) • 1 in 5 people living with HIV are unaware of infection (~18% in the U.S.) • Having long-term controlled HIV infection shows ↑ risk of Cardiovascular disease and Osteoporosis/Osteopenia

  9. HIV Nutrition & Complications Wasting Syndrome

  10. Wasting Syndrome/Disease • Defined as • Involuntary weight loss (skeletal muscle and adipose tissue) greater than 10% from baseline OR • Chronic diarrhea OR • Documented fever for more than 30 days • AND associated weakness • In 2002, wasting incidence rates as high as 10.6/100 in HIV-infected women. • Nutrition for Healthy Living Cohort: 33.6% incidence rate in 2000.

  11. Wasting Syndrome Cont. • ↑ rate of survival if overweight or obese • Presence of opportunistic infection:

  12. Clinical Findings Consistent with Wasting Disease Subjective • Lethargy • Anorexia • Food Insecurity • Loose Fitting Clothing Physical Function • Difficulty or inability to stand w/o assistance Vital Signs • Unintentional weight loss • >10% • >5% within 6 months • BMI • <18.5 or marked decline from usual BMI • Mid-upper arm circumference • <10th NHANES percentile Physical Findings • Head • Temporal wasting, periocular edema or fat loss, prominent zygomatic process • Torso • Subclavicular muscle loss, angular shoulders, visible articulations of ribs at junction with sternum • Sacral edema (in bed rest/bound patient) • Extremities • Diminished mass interosseous dorsalis when pressing thumb to forefinger • Diminished mass quadriceps femoris and vastus medialis when leg bent at right angle • Delayed mid-upper arm skin fold return, loss of turgor • Lower extremity edema √ √ √ √

  13. HIV and Nutrition • Maintaining good nutrition may help: • Limit weight loss • Reduce risk of infections • Diarrhea • Lipodystrophy (fat distribution syndrome) • Limit nutrient deficiencies • Help process medications and manage side effects • Keep immune system stronger

  14. Basic Principles of HIV and Nutrition • General Healthy Diet • High in vegetables, fruits, whole grains and legumes • Choosing lean, low-fat sources of protein • Limiting sweets, soft drinks, and foods with added sugar • Balanced meals: protein + carbohydrate + little good fat • Multivitamin-Vitamin A, C, E, B Vitamins, Selenium and Zinc • High-Energy • High-Protein • 1.5 g/kg • Mediterranean Diet? • Physical Activity

  15. Nutrition Assessment Diagnosis Intervention Monitoring and Evaluation

  16. Initial Assessment • Assessing for: • Admitting diagnosis of HIV • Albumin <2.5, • New Tube Feed • Braden Scale Score = 21; No skin breakdown • IV Fluids: NS @ 100mL/hour • Receiving folic acid • Regular diet

  17. Initial Assessment Cont. • Sister and mom state concerns for pt’s mental status and not able to take care of him • Conflicting reports of 110# weight loss over 8 months versus 5 years per H&P and MD notes • Per physician, pt on nightly tube feed regimen (unsure of formula)

  18. Nutrition Assessment: Medications

  19. Nutrition Assessment: Lab Values

  20. Subjective: The Call (Unable to visit 2° to TB Precautions) • “Lost 110# in 2 years” • Top weight 216#; ↓ after bit by a recluse spider • Reports good appetite and cooks for himself • Has PEG tube for medication administration 2° to pill dysphagia • “I put (pureed) Cornish hens, corn dogs, and protein supplements down PEG tube” • Unsure of home tube feeding formula

  21. Diagnosis Problem = Underweight Etiology = related to HIV Symptoms = as evidenced by need for supplemental enteral nutrition

  22. Intervention • Estimated Energy • 35-40 kcal/kg: 1855-2120 kcal • Estimated Protein • 1.4-1.6 g/kg: 74-85 grams

  23. Intervention • Recommend initiating nightly tube feedings • Boost Plus 60mL/hour over 12 hours (20:00-8:00) • 1080 calories, 42 grams of protein and 555 mL water • Initiate Calorie Count x 3 days • Monitor and encourage adequate po intake • Monitor weight and labs • Recommend education on proper PEG tube feeding/care before discharge • IPOC

  24. Monitor & Evaluate • Po intake per RN note • Weight

  25. Monitor & Evaluate • Calorie Count and Tube Feeding

  26. Monitor and Evaluate • Calorie Count & Tube Feed Assessment • Average calorie intake = 44% • 816 calories • Average protein intake = 41% • 30 g protein

  27. Monitor and Evaluate • Labs

  28. Ending Diagnosis • Lung masses (two cavity) s/p bronchoscopy; no hemoptysis or persistent coughing • HIV/AIDS treatment • Hyponatremia --- resolved • Hypokalemia --- resolved • Malnutrition with cachexia, 2° to mass & HIV • Pancytopenia 2° to HIV • Chronic pancreatitis

  29. Where is he now? • Key West? OR • Camper in Clendenin? • To be continued…

  30. References • Centers for Disease Control and Prevention: http://www.cdc.gov/hiv • http://www.webmd.com/hivaids • www.aidsinfonet.org • Fazia, A. (2012, October 01). Hiv and nutrition. http://emedicine.medscape.com/article/2058483-overview • AND Nutrition Care Manual • Mahan LK, Escott-Stump S. Krause’s Food and Nutrition Therapy: 12th ed. 2008

  31. Questions?

More Related