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Merged Document 4
Merged Document 4
NCP
illF-
f2
Diagnosis: Type
Date:09/18/2012
.
. o o o
Diabetes
Age, gender:2d
male ''
Molt ;t1ls
@
'1
Dietary intake: PO
intake t /
o o
Energy,
,1.
proteinandfluidneeds'
Total energy= 2371 kcal Protein= 59.87-74.8491d
o o o
(i
"WrnV)
r r
Labsfiests
(1.0)
,./
o o o o
Hct=MYo,normal
Serum albumin = 4.3 g,ldL, normal (3.5 -5.0 Glycosylated hemoglobin = 9.4%-hjghFasting blood gtucor" =
g/dl)
19189!,
trtgL
Nutrition Diagnosis
Limited adherence to nutrition related recommendations RIT consumption of a poor diet especially for a diabetic. Patient does not monitor U]66OItucose and does not
glucose = 180m9/dL and exercise oftery ,, AE4 excessive hunger and thirst; fasting blood
a-
1.) Meals and snacks a) Raise intake of nutrition dense foods instead of empty kcafhigh kcal foods such as French fries and hamburgers; replace chips and cake snacks wlth
other nutrient dense snack foods; stop skipping breakfast b) Example foods for meals and snacks: nuts, lean meats, low-fat dairy (skim milk, yogurt) vegetables, fruits, lower fat "baked" chips, fish, eggs, diet soda,
etc.
2.)
Nutition-related management a) Make appointment with Exercise Physiologist b) Make appointment with NmriTiTTuEEEi-
Datez@.lt8l2012
Goals
1l Dietary intake to meet >75% of estimated energy needs 2l Learn exercise habits from Exercise Physiologlst 3) Learn to count carbohydrates within l week to help maintain blood glucose
4)lffi,bbodgruco,"r.,"r-h*'t[h$[,J#91,?h4^g,f#k4fi
blood glucose 34times per/day
;t)
Monitorirg and
eva
luation
r o o r
/)
Follow-up phone call after 3 days or 1wk later Ask the patient to do 3day food record and blood glucose torel log and bring it to the clinic to reassess blood glucose level Follow up egaln within 2 wks forexercise progress
Consult MD if the patient's blood glucase remains high following initiating new diet and exercise plans
rlb frt
c c*terk
7,
-l
l
NCP
#5 Diet Lab
rclLs/2A12
Nutrition Assessment . Age, gender: 2Z,female . Dietary intake: PO intake . Symptoms: NIA . Anthropometric measurements: o HUwt= 5'4"1162.56 cm and 220# 199.79k9
ffa l-/
'
o o
Enersv'
proteilil:,ti::H3*
'.
4.46kcard
t/-/
with actuar heisht and weisht with active rirestyre
Protein=l2.S7gld
Fluid= 3991.6-5987.4 mUd
Basld
"Pi"i::lf#;::?'13#r,""essor'prosram
factors included.
. .
Energy
Kcal
For protein, used "Food Processor" program and non-stressed state. For fluid needs, used 40-60 mUkgld
(e) 105
Fiber (g) 39
Vit A
(ue) 3650 s000
73
Vit
vit c
{me) 30 75 100
lron
(me) 69.86
18
Ca
(ue)
(mg) 805
1000
Recall
DRI
1285
22.25
15
%DRI Eval.
I
2864.46 44.86
Normall weightloss
40.10 97.25
Normal
34.9L Normal
72.57 176.38
High
Normal
148.33 Normal
257.65
High
80.5
Normal
Normal
Nutrition Diaqnosis I High sodium intake and obesity R/T Nl - 4.465m9 and previous high kcal diet AEB %DRl 194.13a/o sodium atter 24hr
recall and
BMI-
37.Bkglm2.
\-
Nutrition
lntervention
-/
1.
2"
GoaIs
Meals and snacks a. Lower sodium meals b. Salt substitute or other seasonings c. Replace pre-packed foods with raw d. Choose "reduced/low sodium" pre-packaged foods Nutrition-related medication management a. Continue exercise for t hour (+) most days of the week
_/
1. 2.
Monitorinq and Evaluation . Follow-up phone callwithin one week . Request 3-day food record to compensate for non-atypical days
r "
Reassess %DRl for sodium to see if it is within normal range <2300 Request a log of weight every 2-3 days
=--
ExPeriment: Cholesterol
Date:10/17lzAn
Recorder: Lauren
a a
Age,
gender:*lmate
Dohefi
a
a
Anthropometric measurements o Ht/wt: 6'1{ / L85.42cm and 245# /1-L1.13kg o BMI= 32.3 kglm' (obese)
o rBW=
o
o o
18zr#
rtr.;;il,
Total energy=
;iBW= r33.rurrro
,oo"r", ,4r5w
qO'
551c1
-
Protein="67 76R8-83,,1519/d
?a.4i
Fluid=J5O3*3.i92;LJ3,5+rLld
f.: ?g E$-6#trA30-35kcal/kg
*.8 7 Y -fl|9
ld^Y
"a1:
REE
Labs/Tests
o o o
o o
Cholqsterol24o m&/dU(highl
Hgb: 15.2
g/dl(normal) Hct:43%(normal) . /
Nutrition Diagnosis
Overweight/obesity R/T high fat/kcal diet and no exercise pattern AEB BMt (32.3
kg/m') in obese range, TolBW (L33.L52Lo/o) also in obese range, and total cholesterol is high l24O mg/dL., Nutrition lntervention
1.) Meals and snacks
I
,----
a)
b)
oatdteal, cheerios, low fat dairy products, fruit, egg whites, bran muffins, whole wheat toast, etc.
Breakfast
Snacks
baked reduced fat chips, vegetables (broccoli/carrots) dipped in lightffat free ranch
Lunch
c)
d) a) b)
Goals
Dinner
Exper.ft vreet,ehoilEsterd
traG @,Er@Z
l-2lb#wk until IBW or normal BMI is reached 3) lowerc@sBeml to <2fr]ragfdlwithi* 6 months 4\t Segia esercitiBigr@diateb.fiofu{ng appointnrent with Exercise Physiologist
2) Weight hss of
FO&w-trypMe*f u* hterto
Ask the
inquire
ahut
FtfuntF.fto
iFG
reassess
a.
Reassestffitolin
dnicto
Experiment: HDULDL
DatetL0lz,,lz0tz
a a a
a a
Anthropometric measurements o Htlwt: 5'q' / t62.56cm and L48* 167.1317kg BMr=25.4kslm'(stighttyabovenormat) IBW= 120# / 54.4311kg, %lBW= 123.3333% (slightly above normal) Energy, protein and fluid needs
o
o
o o o
Oie,VWBiUYff
,/
0V&9
A \ &' I -
Total
enerq:
L7L4.8727-212?.L757
kcauday
Protein= 83.9146
- 100.6975g/day ,/ -
r
I I
For edergy, used Mifflin St. Jeor with current BW X activity factor 1.3 with injury
factor of 1.05
For protein, used: current BW X {1.25-1.5}e PR0/ke/day For fluid needs, used current BW X 1
mVkcafday
Labs/tests
o o o o o o o o o o
Nutrition Piasnosis Undesirable food choices RII'lack of nutrition knowledge/unhealthy diet AEB lipid profile, high TG (250m9,/dL), HDL low (34mgldl), high cholesterol l240meldLl, high LDL (156mC/dL), 1209/dayfat intake vs. 659/day DRl, high %lBw (123.333%) Nutrition lnterventlon
1.) Meals and snacks
a)
oatmeal, cheerios, low fat dairy productt fruit, egg whites, bran muffins, whole wheat toast, etc.
Breakfast
bl
c)
Snacks
light/fat free ranch, bran muffins Lunch - lean turkdy or chicken sandwich on whole wheat bread from home, salads with light dressing
Experiment: HDULDL
dl
Oinner
lean chicken breasts, cooked vegetables, rice, light pasta dish, etc.
c)
Goals
Start new diet immediately following appointment with Nutrition Educationist; meet neyu kcal intake
\ f .$U VV
LDL
to <130m9/dL)
Follow-up phone calUvisit in hospital lwk to inquire about new diet and exercise plan Ask the patient to do 3-6 day food record after first week to reassess
a
a
34 months to determine if within normal Reguest a log of the patient's smoking; how many cigarettes each day et9
Reassess cholesterol, LDL, and HDL in
ranges.
Date:1U06/2AL2
a o
a a
Anthropometric measurements o Ht/wt: 5'8" I L72.72cm and L66* 175.2963kS o BMI= 25.2 kg/m'(overweight) o IBW= 154#/69.8532kg, %lBW= 1O7.7722L% (ovenryelght) Energy, protein and fluid needs
o o o
\rrison
ol1
r .
Labsfiests
Benedict Formula with current BW X activity factor for non-injury to determine REE/day
I mVkca/day
o o o o o o o
Cholesterol 188 mg/dl (normal) TG:89 mg/dl(normal! Glucose 112m9,/dl (normal) Albumin 3.89/dL (normal) Serum Ca = 9.8m9/dL (normal) Urinary
Ca = 3@mgy'day (hieh)
Nutrition Diagnosis
Urinary Ca is high; imbalance of nutrients R/f hieh protein intake and no Ca intake AEB high urinary Ca (300m9/day) and the self-reported intake of 1509 protein/day vs- DRt based on IBW
of55.88255-69.8s32s/day
Nutrition lntervention
1.) Meals and snacks
pro/day
/ V
a)
orange juice, oatmeal, cheerios/nutrient dense cereals, fruit (papaya/oranges,) egg whites, bran muffins, whole wheat toast, etc. Breakfast
b) Snacks *egetables
c)
d)
a)
lowered intake and lean meats; turkey or chicken sandwich on whole wheat bread from home, salads urith light dressing and 3oz serving of
chicken on top
- lean chicken breasts, cooked vegetables (collard greens/kale,) rice, pasta light dish, fish/salmon, etc.
Dinner Referral to Nutrition Educationist for protein/ca interaction information
Date:1U06l2012
b) C,a supplementation
Goals
of Sfilmg/day
Start new diet irnmediatelyfollowing appointment with Nutrition Educationisg meet new DRI for gfitms protein/day
2l Meet fluid intake requirements 1860.2854mVday 3l Begin Ca supplementation and 4l Begin Ca rich foods intake immediately s) Lourer urinarya to flormalvalue {1@240rng/d} within 2-3 weeks
Monitoring and
evaluation
Follow-up phone call within
Ask the pataent to do
o
a a o
3{
,P
\
Experiment: Triglyceride Date: 09/28
l20t2
a a o
Anthropometric measurements
o o o o o
Ht/wt:5't"
BMt= 28.7
kg/m'(ovenrveight)
/ llbtgrl
r r r
ntld
/ a(|n y
\BW (50.60389kg) x 30-35kcal/kg to determine For protein, used: wilkins Alw (50.60389kg) (0.80-1.0olg PRo/kg For fluid needs, used Wilkins ABW {50.60389k9 1 mUkcaUday
For energ'y, used Wilkins
Labsflests
o o o o o
Serum albumin: = 4.2 gldl- normal (<3.8 Hgb: 13.4 g/dl (normal)
g/dl)
Hct:41% (normal)
Blood Glucose: 145 mg/dl(hiehl
TG:250
me/dl(high) '-
Nutrition Diagnosis
.-0.4
torng
wwpf,iovT
Adeqnateiroaintafte; high B%He tg_beine overweighf TG high and high fat diet and no exercise
andrG 2s0mglfllhishl
t
tBG:L!ffr;':x':Tq lu
ovenre,*n,@"'S; ifi
of 't W--frro dE +
tc-l
Nutrition lntervention
1.) Meals and snack
a) b)
Needs
to lower fat and carbohydrate intake; raise fiber and whole grain
intake. Replace high fat foods like chips, candy, and fast food. Example foods for meals and snacks: nuts, whole grain breads/pastas, fruits, vegetables,lean meats
etc.
,/
a) Z
Goals
1)
2l Weight loss of l-2!bs/wk until IBW or normal BMI is reached 3l LowerrGlevelswithin3-4months fU What ltvel ? N \VWLI 4l Lower carbohydrate intake/learn to count carbohydrates, lower BG
5)
Begin exercising immediatelyfollowing appointment with Exercise Physiologist
=ffi:ytEry;f+ ? ti:y'.3
iili:
-,'?smEFtIw;Effii{q:
-'p. Foll*up pttore EEEEE!, to inquire abo*rt mr det and exercise plan . \"-:-]1r. " &a Askth6.?a#erltto *yfoot*reeod kandbringitintotheclinicto
i
r Askfioia hgof ttre @r*ee*irEEEi#Ar/aay o MgcTGffiiE }4mrths to det=iffiifiEiftrfthin normal ranges. o Tractffif,!ry-S6h/s and brilEiffiSnk to re&ss after 2 urceks
raa$Bss
...-.'?
; {fr(*
lh
...
,l
Date:O9lL6l2OL2
o . o . o
Anthropometricmeasurements o Ht/wt: 5'5" I L65.Lcm and LLz# | 50.9k9 o e]/.l=Ls.7 W (normal) o IBW= 125# / 56.8k& %UBW= 89.6% (mild malnutrition) p UBW= t23*155.9k9, %UBW= 91% (mild malnutrition) loss: 8.9% (mild degree of malnutrition) "\3* Energy, pr.fein and fluid needs '
o o o
t782mlld
For energ'y, used Harris-Benedict formula to determine REE then multiplied by
r r o
Labsfiests
activity (1.3) & injury factor (1.3-1.5) For protein, used stress factor for tumor: {1.0-1.25 g PRO/kg
For fluid needs, used 35 mykg/day
o o
z.ffitow
tuj:6.0 ddL)
(<3.8
e/dl)
,./
Nutrition Diagnosis
lnadequate protein intake (or inadequate energy intake) R/t poor appetite and N/V caused by chemotherapy;!!fu90% lBW, 8.9% wt loss, low total protein and low serum
albumin.
Nutrition lntervention
1.) Meals and snacks
a) Supplemental protein drink TID between meals b) Examph fioods for meals and snacks: nuts, meats, dairy (cheese,) soy
2.)
products (tofu & soy beans,) fish, eggs, etc. Nutrition-related medication management
a)
Goals
REC
appetite
stimulant
U Dietary intake to meet >75% of estimated energy needs 2l Weightgain of 1#lwk until pt reaches ee""v" 'v' UBWIIBW 3) Protein need: 50.9-6 3.6 Etd '/
atbumin h..ySST
r tullqrui*ii 'ffi r 3 dS or 1 n* later . Asksle-Ftt&httodokyfuod rcsd ard brirg ittothe clinicto reassess BW, protein
inta*e have increas(dfut*
ffiffa*,*lt
{ u*s to detennine if within
normal
/.
Se.assess
tod'proEtn
ranges.
hf;B-bofiuefiht
-ard
tr,
Anthropometric Lab
NCP
Hamwi BMlz L72(106# for the first 5 feet + 6# for each additional inch; 6 X 11 = 66 + rcA % IBW: t}6.g?%ll84lt72= 1.0697 X 100 = 106.97)
=*6
-/
Comment : The subject is within the ideal for %lBW in contrast to the Life lnsurance Table Weight Ralrge which shows that he is 19# overweight of the maximum weight in the range for his
2. Body Mass lndex (BMl)
BMI : 25.7kglmZ t83.6ke/1.8034m2 = 25.705)
height. ',/
Category: Overweight
3. Waist-to-Hip Ratio
Waist:85.09cm Hip:105.41cm
Wa ist-to-Hip Ratio: .807 ( desirable) {85.09/105.41 = .&O7 22891
Comment: Preferred ratio for men is <0.9; the subject falls within the preferred range.
4. Arm Circumference and Triceps Skinfold Comparison
_/
Trlceps:7mm,25s %ile Mid-arm Circumference: 342.9mm Arm Muscle Area:7200mm2, 75-90th %ih TotalArm Area: 9200mm2 Arm FatArea: 2000mmmm2, 50-75d'%ile {920G7200 = 20@)
5. Body Composition
A. Circumferences
Abdomen Constant 29
Buttocks Constant:42
Anthropometric Lab
NCP
Lauren Doherty
1A BL/?.OL2
34.5
10 = 29.S)
/
Mean
Skinf{ds
4.4mm
12.8mm
Sum: 30.7mm = X1
Abdomen:
Mean 4.4mm
8mm 7.5mm 8mm 7mm 7.5mm 7.4mm Subscapular: 13mm 12mm 12mm 13.5mm 12.8mm Abdomen: 12.5mm 14mm 14mm 13.5mm 13.5mm
Suprailiac:
Midaxillary:
8.5mm 10.75mm
10mm
(4.4 + 8 +7.4 +12.8 + 13.5 + 8.6 + 10.75 65.51 Sum: 65,5mm X3 = = Body density from 3 skinfold sites: 1.078 (1.1093800 - (0.0008267 x 3o.7) + 0.0000015 (30.7)? Body density farT skinfold sites: 1.078 t-trz- (0.00043499 x 6s.5) + 0.000o0055 (5s.sl2
0.0002574
(ltl * 1.s7s
-0.00028826x21= 1.078
Three Site Skinfold Sgdv Comoosition Results Bodyfat: 7.67k9,9.18% {83.6 X .0918 = 7.67;7.67183.6 X 100 = 9.18} Lean Body Mass: 75-93W,90.78yo (s3.6 - 7.Gt = 25.93; 75.93/83.6 x 100
Seve,n Site Skiqfold Bodv Cqmoogition Res,ults
= 90.78)
x .0918 = 7.67;7.67153.6 X 100 = 9.18) Lean Body Mass: 75.93 k9 90.78% {s3.6- t.6t = 7s.93; 7s.93/83.6 X 100 90.7s) =
D. Hydrostatic weighing {gold standard to estimate body fat} Residual Volume (RV) 1.49
Vqvtttrrrn? -,\
tJ
l
I
Anthropometric lab
NCP
Lauren
Dohefi LOl3t/}Otz
Ave:3.701(UWW) 3.70110.995671- 1.119 = 1.0615)
= 0.1952 X 100 = 19.52) 16.32 = 67,28;67.28183.6 = .8047 X 1@ = 80.478)
Comment: Each body composition measurement yielded a different % body fat with the exception of the three skinfold and seven skin fold measurements which both yielded a 9.18% body fat whlch were also the lowest. Circumferences yielded 26.5%,BlA!5.7%, and the Hydrostatic weighing yielded 19.52%;
an average of all five %'s yields a 16.015% body fat which is very close to the 19.52% from Hydrostatic
{gold standard.} ln this case the skinfold measurements were likely the least accurate.
I Experiment: Hemoglobin/Hematocr it
Date:09/21 r2o'2
female
/ ,r/
ryprJ, n1 *o * V9lLtzr'a' n
8
a a o
rn*
Anthropometric measurements o Ht/wt: 5'4" I L62.56cm and L08# /48.988kg o BM|=-19fJ--klmi (mito malnutrition) o IBW= 12O# l54.43LIkg, %lBW= 90% (mild malnutrition) Energy, protein and fluid needs
n,z [*flpl
nO.7
o o o
Total ener$y= 277 6.LO43-227 6.7O43 kcal Protein= 55.54488-66 .a31L g/d
Fluid= 2176.L043
r r r
mlld
For energy, used Mifflin-St. Jeor formula to determine REE then multiplied by
activity (1.3) & injury factor (1.0) +500kcals for lactation \.For protein, used: (0.80-1.00 g PRO/kg
For fluid needs, used L ml/kcal/day
_/
Labs/Tests
o
e
Total PRo = 5.5 g/dl, low (<6.0 g/dl) serum atbumin =2.8eldL,y98 c/dr)
Nutrition
Diagnosis
ftW
lnadequate iron and energy intat<e d-geqib timited vegetarian diet, stopped taking vitamins and minerals prescribed by MD, and lactation AEB Hemoglobin = 9.5% (low)
and Hematocrit = 30% (low.)
Nutrition lntervention
1.) Meals and snacks
a) b)
2.)
Needs 95% or greater of energy needs and increase overall iron intake.
Example foods for meals and snacks: nuts, soy meats (tofu & veggie
1) Dietary intake to meet >95% of estimated energy needs; start diet immediately 2) Begin taking vitamin and mineral supplements immediately / 3) Weight gain of 7#lwkuntil pt reaches IBW 4) lncrease overall iron intake from supplements and energy intake 5) lncrease Hemoglobin with iron rich plant foods 6) lncrease Hematocrit %
Monitoring and evaluation
Experiment'l'tertroglobin/Hematocrit DatetAgl2l/z0tz
o r o
Follow*up phone call after 3 days or 1wk later Ask the patient to do 3-day food record after first week and.bring it in to the clinic to
reassess if BW and iron intake have increased ftonr previous visit
Re-aSsess HerSoglobin and Hematocrit in 90-100 days (4 months)
normalranges.
'.1
to determine if within
:'j
;
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h*;
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