Sage Nutrition Science Department - NCP Form Walker

Patient: Mr. N

Case 7

Alicia

Referre for: Nutrition consult s!p "astroesop#ageal Reflu$ Disease %! &'N

NUTRITION ASSESSMENT
Food and Nutrition Related History: Alco#ol intake( )-* +eers ,-- times!%eek( gaine almost ,. l+s since knee surger/0 ecrease in a+ilit/ to run( no replacement e$ercise1( PA consists of pla/ing %it# #is c#il ren( stress-relate increase in rinking an eating in past /r( famil/ #istor/ of #eart isease( no follo%ing of iet restrictions( #is %ife purc#ases!prepares foo or #e eats out. *--#our recall in icates #ig# intake of calories an fat 0saturate 1(c#olesterol( an so ium. Anthropometric Measurements Age: "en er &t: Wt: *). l+s! 47 kg 9M:: -2 /o M .345 Wt &$: gaine ,. l+s since surger/ ,).7 kg!m* )7..*6cm 0./o1 Mil l/ o+ese 7 Wt c#ange: )*87 Biomedical ata! Medical Tests " #rocedures ;a+s!Dat Al+umin "lucos C#olesterol 9<N Creat Na= >= &g+ &ct MC? @t#er e e 4!** -.4 ))8 **8 mg! ; )*.2 8.7 )--.. )-.8 -87 2. &D;-C- *8 mg! ; D Aen of Aen of A mg! ; mBC!; mBC g! ; Den Em, ;D;- )6. mg! ; A scale scale Aen of !; Den of of ;D;!&D; ratio- 2.*. A scale scale scal 'rigl/ceri es- )72 mg! ; e A Medical ia$nosis%#MH%Rele&ant 'onditions: Bssential &'N-D$ ) /ear ago( s!p R knee art#roplast/ . /ears ago( Fat#er #a CAD( #eme foun in stool( mil l/ o+ese. Pen ing &ematolog/( C#em *-( Am+ulator/ -2-#our p& monitoring %it# 9raFo'M p& Monitoring S/stem( Bn oscop/ %it# +iops/ to r!o H. pylori infection( an 9arium esop#agram 0reCuest ra iologist to attempt to emonstrate reflu$ using a+ ominal pressure an positional c#anges1. #ertinent Medications( at #ome- Atenolol .8 mg ail/0treats #ig# +loo pressure an c#est pain1G ,*. mg aspirin ail/0t#ins +loo 1G multiFitamin ail/G .88 mg i+uprofen t%ice ail/ for last mont# 0NSA:D-treats pain1. :n #ospital- omepraHole ,8 mg eFer/ am0treats "BRD( #eart+urn( stomac# ulcers1G ecrease aspirin to 7. mg ail/0 ue to possi+le ": +lee 1G D!C self-me ication of i+uprofen ail/ S)in status: X :ntact Pressure <lcer!Non-#ealing %oun G Comments: None #hysical Assessment: mil l/ o+ese( mil l/ istresse Estimated Nutritional Needs Based on 'omparati&e Standards: Calories Protein Flui M- RMRI 04.44$47kg1=06.*.$)7..*6cm17.-28 gm protein! a/ *(888-*(.88 m;! a/ 0-.4*$-2/o1I)2,7.*-. 8.2 gm!kg! a/ )m;!)kcal! a/ )2,7.*-.$).* AFI*(*88 kcal! a/ Diet @r er Fee ing A+ilit/ @ral Pro+lems :ntake None X :n epen ent C#e%ing Pro+lem X "oo 0J 7.71 ;imite Assistance S%allo%ing Pro+lem Fair 0appro$. .871 B$tensiFe!'otal Assistance Mout# Pain Poor 0K.871 N!A X None of t#e A+oFe Minimal L 0K*.71 NP@ No Nutritional Diagnosis at t#is time X Procee to Nutrition Diagnosis 9elo%

NUTRITION

IA*NOSIS
B 0Btiolog/1 Mfailure to a Nust for lifest/le c#anges an ecrease meta+olism 0aging!&'N1( failure to a Nust for restricte motilit/ ue to recoFer/ from surger/ MMMMMMMMMMMMMMMMMMMMMMMMas eFi ence +/: B 0Btiolog/1MFoo -an nutrition-relate kno%le ge eficit MMMMMMMMMMMas eFi ence +/: S 0Signs O S/mptoms1 "aine ,. l+s in t#e past . /ears 0claims ue to surger/1( 9M:- ,).7kg!m*( caloric intake as relate to *--#our recall of almost ,(.88 kcal 0*(*88 kcal estimate energ/ nee s1 S 0Signs O S/mptoms1 As s#o%n on *--#our recall'otal fat-,67 of calories 0*8-,.7 recommen e 1 Saturate fat- ))7 of calories 0K)87 recommen e 1 FreCuent large portions of #ig# fat foo s

P 0pro+lem1MB$cessiFe Bnerg/ :ntake 0N.:. ),1M MMMMMMMMMMMMMMMMMMMMMMMMMMMMrelate to: P 0pro+lem1MB$cessiFe Fat :ntake 0N:..6.*1M MMMMMMMMMMMMMMMMMMMMMMMMMMMMrelate to:

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As s#o%n in la+sC#olesterol- **8 mg! ; A ;D; c#olesterol- )6. mg! ;A &D; c#olesterol- *8 mg! ;D 'rigl/ceri es- )72 mg! ; A

INTER+ENTION
Nutrition Prescription: DAS& iet--lo% so ium( #ig# calcium( magnesium( an potassium( lo% in fat( #ig# in fi+er( emp#asis on fruits an Fegeta+les( re uce package an processe foo s. ;o% fat an +alance iet %ill also #elp to ecrease s/mptoms of "BRD 0especiall/ if #ig#-fat foo s are possi+le trigger1. AFoi ance of alco#ol intake. Foo or Nutrient DeliFer/: Nutrition e ucation: Small freCuent meals sprea t#roug#out t#e a/ DAS& iet e ucation- inclu ing foo s t#at fit %ell %it# t#is iet AFoi eating ,-- #ours +efore l/ing o%n Nutrition Counseling: Coor ination of Care 0refer to1: 9e#aFior c#anges nee e . "oal0s1: DAS& iet initiate %it#in ) %eek( %alking!PA initiate %it#in ) %eek 0complete ,$!%eek( ,8 minutes!actiFit/1( Weig#t loss of ) l+!%eek

MONITORIN* " E+A,UATION

:n icators: Weig#t 'otal energ/ intake PAR Criteria: Weig#t loss )l+!%eek *--#our recall 0 ecrease calorie intake( closer to *(*88 kcal recommene ( #ig#-fat foo c#oices at a minimum( ecrease so ium intake1 PA initiate *$!%eek %it#in , %eeks( actiFit/ uration of ,8 minutes

Case Stu / Ruestions *.1 '#e lo%er esop#ageal sp#incter 0;BS1 pressure pla/s a large role in gastro-esop#ageal reflu$ isease 0"BRD1. W#en t#e ;BS pressure ecreases( stomac# aci is a+le to pass up into t#e esop#agus( causing amage an s/mptoms of reflu$. Fat lo%ers t#e ;BS pressure( along %it# to+acco( peppermint( an caffeine. ,.1 Complications of "BRD inclu e #eart+urn( esop#agitis( #ital #ernia( an 9arrett3s esop#agus. &eart+urn is a s/mptom of t#e isease. Bsop#agitis is t#e inflammation of t#e esop#agus an results ue to prolonge e$posure to aci . '#is e$posure can cause esop#ageal erosions( ulceration( scarring( stricture( an sometimes /sp#agia. &ital #ernia occurs %#en a portion of t#e upper stomac# moFes a+oFe t#e iap#ragm. '#is causes t#e esop#ageal #iatus to +e compromise ( an reflu$ contents remain a+oFe t#e #iatus longer. '#e prolonge aci e$posure can en#ance s/mptoms an complications. 9arrett3s esop#agus is a precancerous con ition %#ere t#e normal sCuamous epit#elium of t#e istal esop#agus is replace +/ an a+normal columnar epit#elium. '#is is kno%n as specialiHe intestinal metaplasia. Can increase patient3s risk for a enocarcinoma of t#e esop#agus. -.1 &. p/lori are a +acterium t#at is t#e most common cause of gastritis( t#e inflammation of t#e stomac#. '#is +acterium isrupts t#e mucosal integrit/ of t#e stomac#. '#is +acterium is some%#at resistant to t#e aci ic p& of t#e stomac#. 'reatment for t#is +acterium inclu es anti+iotics an aci -suppressing me ications. )7 of in iFi uals %#o get t#is infection eFelop stomac# cancer. 6.1 A #ematolog/ tests inclu e la+orator/ assessments of +loo formation an +loo isor ers 0Full +loo count( +loo film( etc.1. A C#em *- is a +loo test to assess la+ Falues. Am+ulator/ -2-#our p& monitoring measures t#e aci present in t#e esop#agus( gol stan ar for "BRD iagnosis. '#e +arium esop#ogram is a me ical imaging proce ure use to e$amine t#e upper ":. '#is inclu es t#e esop#agus( an to a lesser e$tent( t#e stomac#. 9arium coats t#e esop#agus an proFi es an opaCue imager/ for $-ra/s. S%allo%ing action is P'/pe #ereQ

Fie%e . '#e en oscop/ %it# +iops/ to r!o &. p/lori is a proce ure one to e$amine t#e esop#agus an ": tract to see if ulcers are Fisi+le( infection( or +ot#. '#is is one ue to +loo foun in t#e stool. 7.1 '#e patient iscusses e$periencing increasing in igestion almost constantl/. &e takes 'ums seFeral times ail/. Recent %eig#t gain 0%it#in last . /ears1( #ig# caloric intake( #ig# fat intake( takes aspirin ail/ an i+uprofen t%ice ail/( alco#ol intake( +loo in t#e stool also contri+ute to #is iagnosis. 2.1 '#is is one +ecause aspirin an NSA:Ds can ecrease t#e mucosal integrit/ of t#e stomac#. '#is can increase t#e risk for infection or eFelopment of ulcers ue to "BRD. 4.1 @mepraHole is a proton-pump in#i+itor. '#is rug treats #eart+urn( stomac# ulcers( "BRD( an ot#er con itions causing t#e stomac# to make too muc# aci +/ ecreasing gastric secretions. @t#er rugs in t#e class are pantopraHole an esomepraHole. @t#er me ications t#at are use to treat "BRD inclu e &* +lockers an antaci s. ),.1 Mr. Nelson3s caloric intake is significantl/ #ig#er t#an %#at : #aFe recommen e . &is intake s#oul ecrease aroun )(888 kcal ultimatel/ an #e s#oul +egin a ne% form of p#/sical actiFit/. )-.1 A+normal la+s inclu e c#olesterol 0**8 mg! ; A1( &D;-C 0*8 mg! ; D1( ;D; 0)6. mg! ; A1( ;D;!&D; ratio 02.*. A1( an trigl/ceri es 0)72 mg! ; A1. '#ese coul +e improFe t#roug# iet an %oul #elp to control #is s/mptoms from "BRD an eFen #elp #is &'N. &e s#oul eat #ealt#ier fats( +ut ecrease #is oFerall intake of fats( an calories( in general. &is #ig# +loo pressure an c#olesterol can a to #is risk of #eart isease. Also( e$ercise %oul #elp to lo%er +ot#( #is +loo pressure an c#olesterol. )2.1 Foo :tem Crispi$ cereal Skim milk @range Suice Diet Pepsi Frie C#icken San %ic# Mo ification C#eerios No mo ification Calcium fortifie orange Nuice Water "rille C#icken Rationale &elps lo%er c#olesterol Skim milk is lo% in fat so it3s a goo c#oice for t#e pt. A e +enefits of calcium c#emicals in iet pepsi( an car+onation is +a for "BRD ;ess fat( if #e still is going to eat fast foo ( giFes anot#er foo option to lessen caloric intake Frenc# fries are Fer/ #ig# in fat an so ium 'oo man/ sugar-s%eetene +eFerages ProFi e a crunc#/ snack( +ut less fat Alco#ol %ill ecrease ;BS pressure an %orsen t#e "BRD '#is %ill re uce t#e amount of fat intake Re uce t#e fat an increase fi+er( if skin is eaten Will re uce t#e fat an so ium 9enefits of fres# fruit >eep t#e protein +ut lessen

Frenc# Fries :ce 'ea C#ips 9eer Frie C#icken Potato Sala "reen 9ean Casserole Fruit Sala 9ake 9eans P'/pe #ereQ

Si e sala Water or milk Celer/ Water or milk "rille or 9ake C#icken 0no skin1 Plain +ake potato Fres# green +eans >eep t#e same as long as t#ere is no ressing. Fres# +ean sala

t#e fat Milks#ake FroHen /ogurt

Cream/ froHen treat +ut less fat an more nutrient ense

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