Nutrition Database

Intern Name Jessica Grilliot

Patient Initials MG DOB 5/24/60 Age 53 Sex F Unit/Room# 2108
Admit Date 10/29/13 Admitting Diagnosis Hyperglycemia
Prior Medical History COPD, DM, Fibromyalgia, HTN, Arthritis, Migraine, Leg amputation below knee
Diet Order CCD 4 CHO/Meal Supplements No
If applicable, describe food intake since admission or past 5 days inconsistent PO intake 25-100%
Any Food Allergies / Intolerances? No

Height (in inches and cm) 66 168 cm Weight (in pounds and kg) 181 lb 82.27 kg Weight History Loss Gain
if weight , how much in what time frame? Was loss/gain intentional or unintentional?
Usual Body Weight (UBW) Ideal Body Weight (IBW) 55.6 kg (adjusted for amputation) % IBW 148%
BMI 31.87 (adjusted for amputation)

Social History (occupation, marital status, support system at home, alcohol use, who prepares meal, food secure / insecure, etc.)
Pt divorced with one son not listed in social hx (she mentioned he lives with her when I visited), she prepares meals,
quit smoking 3 wks prior to admission (1 pk/day)


Pertinent Medications (list medications, state what they are used for, and if applicable nutritional implications)
Drug name(s) Indication Nutritional Implication
Lisinopril Antihypertensive Anorexia, decreased wt,
insure adequate fluid
intake/hydration, avoid
salt substitutes, caution
with K+ supplement,
Avoid natural licorice
Elavil Antidepressant Increased wt, increased
appetite especially for
sweets, increased fiber
may decrease drug

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effect, limit caffeine,
caution with grapefruit
Dilaudid Analgesic Anorexia, decreased wt,
increased thirst,
dehydration
Neurontin Antiepileptic Increased wt, increased
appetite, anorexia
Lipitor Lipid Lowering Decrease fat, decrease
cholesterol
Zofran Antiemetic N/A may cause dry
mouth, constipation,
diarrhea, abdominal
pain
Lasix Diuretic Anorexia, increased
thirst
Percocet Analgesic Anorexia, caution with
grapefruit/related citrus

Nutrition related laboratory values
Lab Test
Lab value indicate if
abnormal
high or low ( or )
Nutritional significance if abnormal
Can a nutrition intervention help to correct this abnormal lab value? How?

Na

K

BUN

CREAT


Albumin

Prealb


Glucose
175 H (664 on
admission)
Yes, a diabetic diet can help to lower and
stabilize her BG
HgbA1C
8.3 H

H/H

MCV

MCH


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Iron (Fe)

Transferrin Sat (%)

Ferritin

Vitamin B
12
Folate


Ca

Phos

Mg



Is Patients Skin Intact? Yes No X
If no, Leg Amputation MRSA Surgical Wound X Decubitus Ulcer
If decubitus ulcer, list stage (I-IV) and site(s)
Is decubitus ulcer Improving? Getting worse?
Is any of the following present? Nausea X Vomiting Diarrhea Constipation
Difficulty Chewing Difficulty Swallowing
Unable to feed self Malabsorption Early Satiety Taste Changes

Reminder.for calculations, what was the patients height (cm) and weight (kg) again? 168 cm 82.27 kg
Male Female X Age 53
Any stress factors, activity factors to consider? Non-healing wound


Calculate Energy Needs using
1) Harris-Benedict ------------------------------------ 2517 kcal
2) Mifflin St. Jeor -------------------------------------- 2430 kcal
3) kcal/kg ----------------------------------------------- 2468 kcal
4) Ireton Jones (only use in critically ill) ------- N/A kcal
5) Penn State 2010 equation ---------------------- N/A kcal

What formula did you ultimately use for the Pt & why? Mifflin St. Jeor because pt is obese
Show your work for three of the five methods above used:

Nutrition Database


HB: 655 + 9.6(82.27) + 1.8(168) 4.7(53) * 1.2 (ambulatory) * 1.4 (Non-healing wound, MRSA) = 2517
Mifflin: 10(82.27) + 6.25(168) 5(53) 161 *1.2 *1.4 = 2430
Kcal/Kg: 82.27*25 to 30 = 2056 to 2468













Calculate Protein Needs
How many g/kg would you use & why? 1.2-1.5 because of sx and Non-Healing wound
Show your work:
82.27*1.2 to 1.5 = 99 to 123 g pro


99 to 123 g/day




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Calculate Fluid Needs using
1) ml/kg depending on age ----------------- 2879 ml/day
2) Holliday-Segar method ------------------- 2430 ml/day
3) RDA method --------------------------------- 2745 ml/day
4) urine output (urine out +500ml/day)- N/A ml/day
What formula did you ultimately use for the Pt & why?? RDA method
Show your work for two of the four methods above used:
mL/kg: 82.27*35 = 2879
RDA: 1*2430 = 2430
Holliday-Segar: 1500 + 20(62.27) = 2745




Do you have any recommendations? Recommend Juven BID for increased kcal and pro for wound healing,
Outpt diabetes classes




Interaction with the IDT (Interdisciplinary Team)
Indicate if you had interactions with
any of these other health care team
members while providing nutrition
care / patient care
Describe interactions with or referrals made to any of these
health care team professionals:
Nursing (RN)

Had nurse weigh pt because wt in chart incorrect
Physician (MD)


Social Worker (SW)


Speech Therapist (ST/SLP)


Physical Therapist (PT)


Occupational Therapist (OT)

Nutrition Database



Respiratory Therapist (RRT)


Woundcare / Ostomy Nurse


Physicians Assistant (PA)


Other

Referred pt to outpt diabetic classes

Nutrition Diagnosis (P-E-S) Statement (write 2)
Problem: Increased nutrient needs

related to (Etiology): Increased demand for protein for optimal healing and to maintain muscle mass and immune
support

as evidenced by Signs and Symptoms: non-healing wound, MRSA, PO intake less than 75% estimated requirements

Problem: Food- and Nutrition-Related Knowledge Deficit

related to (Etiology): Lack of prior nutrition-related education

as evidenced by Signs and Symptoms: BG 664 on admission, A1C 8.3, BKA d/t complications of T2DM


Interventions (your recommendation as a dietetic intern)
Will send Juven BID

CHO Control Diet education will also give supply info on Outpt diabetic classes

Encourage Adequate PO intake

Continue current diet

FU per clinical protocol


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Monitoring and Evaluation (how do you monitor this patient, how do you measure progress?)
Continue to monitor nutrition-related labs

Monitor tolerance and acceptance to supplement

Monitor tolerance to diet