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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

Goals
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%