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Case Study:

Diverticulitis
Amanda Smith
Client History
76 year old woman, Caucasian
Some college
Height: 53
Weight: 145 lbs.
BMI= 25.7
Diagnosis: Diverticulitis
Anthropometric Data
BMI = 25.7, Slightly overweight
145 lbs / 63in x 703 = 25.7
IBW = 115 lbs
Hamwi Equation: 100 + 5x3 = 115 lbs
% Ideal Body weight = +26%
Usual Body weight = 140 lbs
% Usual Body weight = +3%
Food/Nutrition Related History
Food & Nutrient Intake
Usual cup of tea and cereal in the morning
Occasionally brings lunch to work- tuna sandwich
Dinner - sometimes order in, Chinese etc., grilled chicken salad - oil and
vinegar dressing
Attitudes & Beliefs
Try to eat heart healthy diet
Keep sugar to a minimum
Supplement Use:
Doctor recommends Vitamin D, calcium, magnesium
Takes supplements most days
Fiber pill daily
Physical Activity:
Moves around during work
Gym 3 times per week - cycling- 20 min and treadmill-30min
Some weight training
Client History
Personal/Social History:
Lives alone
Very self sufficient
Works part time
Moving around a lot at work
Tries to walk around office as much as possible

Family History:
Mother: CVA caused by diabetes
Father: Died of Heart attack
Siblings: Alive, pre-diabetics
Nutrition Focused Physical Findings
Young 76
Maintains moderately healthy weight +/- 5 lbs
Exercises semi-regularly
Restless sleeper
Takes an Ambien sleeping pill most nights to help with sleep
Client Medical History
Gall Bladder surgery - 1969
Gall stones
Colonoscopy - 2012
Blood in stool
Diverticulitis
Irritable Bowel Syndrome Diagnosis - 2000
Abdominal pain
Bleeding
Heart Valve Replacement surgery and 1 bypass - 2015
Aortic valve replacement - new bovine (cow) valve
1 bypass
Pacemaker put in
Cataract surgery (both eyes) - January 2015
Client Medications
Metoprolol Tartrate
25 MG tab - 2 pills/ day = 50mg daily
Blood pressure lowering medication
Simvastatin
20mg/daily
Helps to lower cholesterol
Fibercon
2 daily
Diuretic
Multivitamin daily
Ambien
Sleep aid
Vitamin D3 daily - 2000 IU
Caltrate + D3 (calcium)
Magnesium 500 mg
CoQ10 - 100mg
Heart health
Biochemical Data & Tests
Lab Test Value Reference Outcome
Values

Sodium 145 mmol/L 136-146 mmol/L Normal/Borderli


ne High

Potassium 4.2 mmol/L 3.3-5.5 mml/L Normal

Chloride 104 mol/L 90-108 mol/L Normal

Magnesium 1.9 mg/dL 1.6-2.6 mg/dL Normal

Calcium 9.3 mg/dL 8.6-10.5 mg/dL Normal

BUN 21 mg/DL 6-20 mg/dL High

Creatinine 0.7 mg/DL 0.4-1.0 mg/dL Normal

BUN/Creatinine 30 6-25 Ratio High


Ratio
WBC 6.8 K/UL 4.0-10.5 K/UL Normal

RBC 4.65 M/UL 4.20-5.40 M/UL Normal


Diverticulosis
Presence of diverticula in the colon (Merck)
Small, bulging pouches (diverticula) develop
in the lower part of the large intestine (colon).
(MayoClinic)

Incidence increases with age (Mahan pg. 635)

Combination of colonic structure, motility,


genetics, and lifelong low fiber intake may
play a role (Mahan, pg. 635)

When one or more of these pouches become


inflamed or infected, the condition is called
Diverticulitis
Inflammation or infection of the
diverticula in the colon

Occurs when the diverticulum


develops a small hole that
allows bacteria from the
intestines to be released
(Merck)

Bacteria can be harmful and


cause the inflammation

Can be confirmed by a
colonoscopy (Merck)
Signs & Symptoms
Severe abdominal pain
Fever
Nausea
Change in bowel habits
Gas as well as gas pains
Blood in stool
Treatment options
Antibiotics/ pain killers
Plenty of rest
Clear liquid or bland diet with limited amount of fiber until swelling is
reduced
NPO for some time to allow bowels to rest (if hospitalized)
Keeping the stomach empty by using a nasogastric tube
Surgery if complications occur, not common
Right Hemicolectomy part of ascending colon & cecum removed colon
connected to small intestine (The Ohio State University)
Left Hemicolectomy part of descending colon removed and remaining
connected to rectum (The Ohio State University)
Sigmoid Hemicolectomy part of colon removed and connected to rectum (The
Ohio State University)
Colonoscopy to further confirm if there are signs of colon cancer or irritable
bowel syndrome
Diverticulitis Diet
Clear liquid for the first few days after inflammation
Ex: broth, fruit juices without pulp, tea, coffee (no cream), water
When inflammation lessens, can start adding low fiber
foods back into the diet
Ex: canned or cooked fruits/veg with no seeds or skin
Eggs, fish, poultry
Low fiber cereals
White rice/bread
Yogurt/cheese/milk
After inflammation is over
Foods high in fiber and low in fat
Ex: beans, whole grains, fruits, vegetables
Recommended 25 grams per day for women and up to 38
grams per day for men
Too much can also harm if bowels are too frequent
Need a balance
High fiber foods will help maintain a softer stool to
ultimately help prevent flare ups
Stool can pass through the colon easier
Stay away from seeds, nuts & skins - could potentially get
stuck in diverticula pockets
24 hour recall
Breakfast cup Cheerios
cup skim milk
1 6oz cup of tea, unsweetened
Lunch 1 regular Bagel
1 cup Tuna, canned (store made)
1 tablespoon Mayo, regular (store
made)
cup skim milk
1 8oz decaffeinated coffee
Dinner 1 cup white rice
1 cup Pork chow mein with
noodles
1 cup wonton soup
1 bottle water (16.9 fl oz.)
Snacks 1 8oz container vanilla low-fat yogurt
4oz regular granola
cup blueberries
24 Hour Recall

*39 oz. fluids


24 Hour Recall Nutrient Analysis
Nutrients Target Consumed Status
Total Calories 1608 Calories 1723 Calories Over
Protein (g)*** 46 g 105 g OK
Protein (% Calories)*** 10 - 35% Calories 24% Calories OK
Carbohydrate (g)*** 130 g 221 g OK
Carbohydrate (% Calories)*** 45 - 65% Calories 51% Calories OK
Dietary Fiber 25 g 11 g Under
Total Sugars No Daily Target or Limit 63 g No Daily Target or
Limit
Added Sugars < 40 g 31 g OK
Total Fat 20 - 35% Calories 25% Calories OK
Saturated Fat < 10% Calories 5% Calories OK

Minerals Target Average Eaten Status


Calcium 1200 mg 926 mg Under
Potassium 4700 mg 2245 mg Under
Sodium** 2300 mg 3293 mg Over

Vitamins Target Average Eaten Status


Vitamin B12 2.4 g 12.0 g OK
Vitamin C 75 mg 30 mg Under
Vitamin D 15 g 13 g Under
Total Energy Requirements
Mifflin-St. Jeor Equation:
10 (65.8 kg ) + 6.25 (160.02 cm) - 5 (76) -161 x 1.375= 1,536
kcal/day to maintain weight
Harris Benedict Equation:
447.593 + (9.247 x65.8kg) + (3.098x160.02cm) - (4.330x76)
x1.375= 1,681 kcal/day
Average = 1,608 kcal/day
Calories from Fat = 20-35% = 35g-62g
Calories from Carbs = 45-65% = 180g-261g
25g Fiber
Calories from Protein = 20% = 80g
Vitamin D = 600 IU
Fluids: 2-3 L/daily
Diagnoses PES Statements
Intake (NI-5.8.5) Inadequate Fiber Intake related to
inappropriate food choices as evidenced by 24 hour recall
assessment with intake of 11 grams of fiber as compared to the
standard of 25-30g per day.
Intake (NI-3.1) - Inadequate fluid intake related to
unawareness of the importance of enough fluids daily to maintain
healthy bowels as evidenced by 24 hour recall fluid consumption
of 39 oz. (42% of daily fluid consumption goal of 67 oz. daily).
Clinical (NC 3.3) - Overweight/Obesity related to some poor
food choices as evidenced by 24 hour recall and BMI of 25.7,
slightly overweight.
Behavioral-Environmental (NB-1.7) Undesirable food choices
related to lack of knowledge regarding proper nutritional choices
as evidenced by 24 hour recall of excessive intake of refined
grains (201% of recommended intake) and excess sodium intake
Intervention
Food/nutrient delivery:
Patient will follow a high fiber/ low fat diet when not having any type of inflammation
Patient will monitor the grams of fiber being consumed and keep fiber intake between 25-30g per
day
Patient will monitor fluids and consume 2-3L per day
Patient will not eat nuts/seeds
Nutrition Education
Patient will learn the importance of increasing fiber intake to soften stools
Patient will learn the risk that consuming too much fiber can increase bowel movements and
increase flare ups
Patient will understand the reason to not eat nuts and seeds as these can get caught in the
diverticula pockets and cause inflammation
Patient will learn the importance of maintaining physical activity a few times per week for overall
health and to keep bowels moving
Nutrition Counseling
Patient will adhere to modify diet including increased fiber (25-30g) and fluid intake
Patient will get some type of moderate exercise three times per week (ex: walking, jogging,
cycling, weight training)
Patient will keep track of food intake through food log of her choice
Monitoring & Evaluation
Food/Nutrition- Related Outcomes:
Monitor patients food diary
Make sure fiber consumption is 25-30g/daily
Monitor fluid intake
Monitor the amount the physical activity she is performing with weight checks
Anthropometric Measurement Outcomes:
Have BMI be reduced to WNL between 18.5 and 24.9
Biochemical Data
Have labs redone to show BUN/Creatinine ratio improvement
Sodium improvement
Nutrition-Focused Physical Findings Outcomes
Lose minimal body fat
Maintain physical fitness
24 Hour Recall Original vs.
Modified Diet Original Modified

Breakfast cup Cheerios cup fiber one cereal


cup skim milk 1 cup skim milk
1 6oz cup of tea, unsweetened 1 medium banana
cup blueberries
1 6oz cup of tea, unsweetened
Lunch 1 regular Bagel 2 pieces whole wheat bread
1 cup Tuna, canned (store made) 1 cup Tuna, canned (store made)
1 tablespoon Mayo, regular (store mashed avocado
made) 1 8oz decaffeinated coffee
cup skim milk cup skim milk
1 8oz decaffeinated coffee 1 8oz cup of water*
Dinner 1 cup white rice cup brown rice
1 cup Pork chow mein with 6oz steamed chicken
noodles 3/4 cup steamed broccoli
1 cup wonton soup cup wonton soup
1 bottle water (16.9 fl oz.) 1 bottle water (16.9 fl oz.)
Snacks 1 8oz container vanilla lowfat yogurt 1 8oz container vanilla low-fat yogurt
4oz regular granola 4oz regular granola
cup blueberries cup raspberries
3 oz. carrots
2 tbsp. hummus
1 bottle water (16.9 fl oz.)*
24 Hour Recall Modified

*64 oz. Fluids


24 Hour Recall Nutrient
Analyses Compared
Nutrients Target Modified Original Status
Total Calories 1608 Calories 1559 cals 1723 Calories Improved
Protein (g) 46 g 117 g 105 g OK
Protein (% Calories) 10 - 35% Calories 30% Calories 24% Calories OK
Carbohydrate (g) 130 g 212 g 221 g Improved
Carbohydrate (% 45 - 65% Calories 54% Calories 51% Calories Improved
Calories)* (Whole grains)
Dietary Fiber 25 g 36 g 11 g Improved -
High
Total Sugars No Daily Target or 84 g 63 g High - more
Limit fruits, less
added sugar
Added Sugars < 40 g 28 g 31 g Improved
Total Fat 20 - 35% Calories 19% calories 25% Calories Improved
Saturated Fat < 10% Calories 4% calories 5% Calories OK
Minerals Target Modified Original Status
Calcium 1200 mg 1105 mg 926 mg Under - Improved-
Supp
Potassium 4700 mg 3869 mg 2245 mg Under - Improved
Sodium 2300 mg 2259 mg 3293 mg Improved

Vitamins Target Modified Original Status


Vitamin B12 2.4 g 12.2 g 12.0 g OK
Vitamin C 75 mg 122 mg 30 mg Improved
Vitamin D 15 g 13 g 13g Under - Supp
References
http://www.mayoclinic.org/diseases-conditions/diverticuli
tis/in-depth/CON-20033495
http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-he
althy-eating/in-depth/diverticulitis-diet/art-20048499
http://www.merckmanuals.com/home/digestive-disorders/dive
rticular-disease/diverticulitis
http://cmis.osu.edu/patient-care/colon/lapcolon/
https://supertracker.usda.gov/
Mahan, L. K., Escott-Stump, S., Raymond, J. L., & Krause, M.
V. (2012).Krause's food & the nutrition care process. St.
Louis, MO: Elsevier.

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