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Recorder: Stephanie Congdon

Date: 3/15/18
N302L Case Studies
Nutrition Care Process (NCP): Ca+ Lab

Nutrition Assessment
Diagnosis: N/A
Nutrition‐related PMH, treatments, surgeries: N/A
Age, gender: 67, male
Dietary intake: PO intake
Food preferences, allergies, intolerances: N/A
Exercise habits: N/A
Knowledge, readiness for change: Attending health fair
Functional/behavioral factors:
Resources for obtaining, preparing food: N/A
Symptoms: N/A
Anthropometric measurements
Ht/wt: 68 in/172.72 cm and 166#/75.5 kg
BMI= 25.3 kg/m2, overweight
IBW= 154#/70 kg,
IBW%= 108%, idea (<105%) to overweight (<110%)

Energy, protein and fluid needs

o Total Energy= 1,765-2,157 kcal/d
 For energy, used Harris Benedict formula to determine REE
 REE 1,508 kcal/d, multiplied by activity factor (1.3), non-injury factor (1),
and added range of +/- 10%
o Protein= 60-76 g/d
 For protein, nonstress factor (0.8-1.0 g/kg)
o Fluid= 1,765-2,157 mL/d (1.8-2.2 L/d)
 For fluid needs, used 1 mL/kcal x estimated caloric requirements

Labs/tests – state high, normal, low.

Urinary Ca+ = 300 mg/d, high (100-240 mg/d)
Ca+ Serum = 9.8 mg/dL, normal (8.5-10.5mg/dL)
Corrected Ca+ Serum = 9.56 mg/dL, normal (8.5-10.5mg/dL)

Medications/supplements: N/A
Nutrition Diagnosis- PES format
High protein intake RT high protein and high caloric intake AEB high urinary Ca+ levels 300
mg/d (<240 mg/d), overweight BMI 25.3 (<24.9), and overweight IBW percent, 108% (90-105%).

Nutrition Intervention
1. Meals and snacks
a. Decrease protein intake at each meal/snack by Increasing fruits, vegetables,
whole grains, and legumes.
b. Limit protein intake when snacking by decreasing protein shakes, serving size (4-
5oz), and protein bars.
c. Increase intake healthy fats: walnuts, salmon, flaxseeds, olive oil, and light
canola oil.
d. Decrease caloric intake at each meal/snack by consuming less full-fat dairy,
energy-dense, and high sugar foods.
2. Nutrition‐related medication management
a. Seek medical advice for more lab tests to insure kidneys are working properly

1. Decrease energy needs to meet energy requirements: 1,765-2,157 kcal/d
2. Decrease protein consumption to meet normal range of 60-76 g/d
3. Decrease urinary Ca+ levels to meet normal values (100-240 mg/d)
4. Intake of normal Ca+ from food and/or supplements (DRI Ca 1000-1200mg/d)
5. Intake of normal vitamin D from food and/or supplements (DRI Vit D is 600-800 IU/d)
6. Lose 1-2 lbs a week until IBW weight is met, 154#/70 kg
7. Decrease BMI to meet the normal range, <24.9
8. Exercise a minimum of 30 mins/d

Nutrition Monitoring and Evaluation

 Follow-up phone call in 3-7 days
 Have patient do a 3-day food record and return it to the assessor for review to insure pt
is consuming recommended foods
 Reassess urinary Ca+ levels within 2-3 weeks to see if they are in normal ranges
 Reassess BMI and IBW%