Grand Round

Study: J.R.
By: Elizabeth Greco &
Desiree Wentzell
Demographics
Ethnicity: Caucasian

Gender: Male

Age: 36

Socioeconomic Status: Middle-class

Education: High-school and College graduate

Religion: Not specified

Marital Status: Single

Anthropometrics
Height: 5 10, 70 in BMI: 12in * 5 = 60in + 10in = 70in
70in * .0254 = 1.78 * 1.78 = 3.17
147/2.2 = 66.81
Weight: 147 lbs, 66.8 kg 66.81/3.17 = 21.07 = 21 (Normal BMI)

BMI: 21, Normal Range IBW: 6x10= 60 + 106 = 166 lbs

%IBW: 147/166 = 89%

IBW: 166 lbs
UBW: 165 lbs
%IBW: 89%
%UBW: 147/150 = 89%

UBW: 150 lbs

UBW %: 98%
Social History
Graphic Designer/Social Media Coordinator at local bank

Freelance Graphic Design

Works long days, usually 12hrs

About 5hrs of sleep/night

Enjoys Running (about a mile/d)

Family History
Uterine Cancer (Mother)

Brain Tumor (Father)

**J.Rs parents showed no symptoms of UC

Patient Medical History
Ulcerative Colitis (chronic)

Gastritis (chronic)

Microcytic Hypochromic Anemia (periodical)

Herniation (surgery for correction)

Tonsillitis (surgery for correction)

Pancreatitis (corrected; result of Lialda)

Focus
Ulcerative Colitis

Gastritis

Microcytic Hypochromic Anemia

Diet History

Eats ready prepared meals or fruit for convenience.

Does not consume an adequate amount of protein.

Prefers small amounts of food at meal times to avoid any stomach complications.
Medications & Usage

Sulfasalazine: 2000 mg/d for Ulcerative Colitis

Omeprazole: 40 mg/d for Gastritis

Ulcerative Colitis
An inflammatory bowel disease (IBD) that causes long-lasting inflammation and
ulcers (sores) in the digestive tract. Ulcerative colitis affects the innermost lining of
the large intestine (colon) and rectum. Symptoms usually develop over time, rather
than suddenly.

Signs/Symptoms may include: diarrhea, fever, rectal bleeding/pain, weight loss,

fatigue, abdominal pain, cramping.

Idiopathic, may be caused from immune system malfunction and heredity.

Risk Factors: Higher incidence in caucasians, around the age of 30, with family
history of disease.
Treatment
Drug Therapy: anti-inflammatories, immunosuppressants, antibiotics, pain reliever,

anti-diarrheals, iron supplements

Surgery: proctocolectomy- surgical removal of rectum and all or part of colon.

Gastritis
Inflammation of the stomach lining, most often the result of an infection of the same

bacteria that causes stomach ulcers.

Excessive use of pain relievers and alcohol can contribute to gastritis.

2 types: Acute- sudden onset.

Chronic- appears slowly over time.

**Can be caused from stress, older age, and other diseases, such as Crohns Disease.
Microcytic Hypochromic Anemia
Fewer, smaller RBCs

Caused by Iron Deficiency Anemia

Can be treated with a supplement and diet changes to increase diet intake

Patient does show previous lab values indicating Iron Deficiency

Tests & Labs
Anemia: Ulcerative Colitis:

MCV Calcium

MCH B12

MCHC

MPV
Relation to Nutrition
Vitamin & mineral deficiencies

Malabsorption of B12

Decreased vitamin D can lead to bone loss- corticosteroids can worsen bone loss.

____________________________________________________________________________________________

Limit dairy products, gassy or high fat foods.

Eat small meals, drink plenty of water, experiment with fiber.

24hr recall

Breakfast: Fruit

Lunch: Apple & Banana

Snack: Laffy Taffy

Dinner: Ready-prepared chicken parmesan meal (Wegmans)

Snack: Coco rice wafers

**Drinks adequate amounts of water daily, almost 4000mL

Pros/Cons of Current Diet
Pros:

Does contain fruits & vegetables

Does consume enough water

Cons:

Not an adequate amount of calories

Often contains ready-prepared meals
Nutrition Interventions
Raise calorie consumption

Increase variety

Increase fruit, vegetable, dairy, protein, and carbohydrate intake

Patient Goals
Withstand an adequate diet of substance.

Continue consuming adequate amounts of water.

Nutrition Care Process
A: Physical findings shows muscle wasting, loose skin, rounded shoulders, and
bloated stomach.

D: Ulcerative Colitis, Gastritis, and Microcytic Hypochromic Anemia

Inadequate oral intake (N.I-2.1) related to abdominal pain and diarrhea as

evidenced by reported poor intake in patients 24hr recall.

Malnutrition related to involuntary weight loss as evidenced by 11% weight loss in

three months and 89% IBW.

Nutrition Care Process Cont.
I: Nutrition Education: Educate on high protein, low fat (< 3g per serving), low lactose and low fiber diet and foods
to alleviate symptoms related to UC dx. Educate on bowel movements and fiber relationship. Recommend to
minimize fiber intake and choose low fiber foods. Recommend increase fluid intake, aiming for 2L of fluid daily
with electrolytes, such as Gatorade, Powerade or Pedialyte. Recommend taking a multivitamin/mineral supplement
daily.

Education needs identified: Yes

Handouts provided: High protein, low fat foods and recipes

Patient verbalizes understanding of teaching instructions: yes

Barriers to learning assessed: none note

Nutrition Care Process Cont.
M & E:

1.)Weight: Goal: gain 0.5-1lb per week

2) Total energy intake: Goal: progression of adding 200 with an end goal of a 2700 calorie consumption.

3) Oral fluids: Goal; 2L/d of electrolyte containing beverages

4) Types of food/meals: Goal: Choose low fat, low fiber, low lactose foods Specialized Nutrition Supplement:

Multi-vitamin daily

5.) Total protein intake : Goal: 60 to 70 grams daily

Nutrition Prescription
Increase nutrient dense food intake.

Progressively increase to calories of 2,200/d.

Maintain water intake.

Take Aways
Symptoms really affect intake of food for patient.

Symptoms are often individualized.

Although a weight may be healthy, it maybe be unhealthy as to how they reached

that weight.
References
Find Diet and Exercise Tips That May Help Your Ulcerative Colitis Symptoms. Crohn's and Colitis, Abbvie, 25 Aug. 2017,

www.crohnsandcolitis.com/living-with-crohns-uc/ulcerative-colitis/diet-and-exercise.

Picco, Michael F., and Elizabeth Rajan. Gastritis. Mayo Clinic, Mayo Foundation for Medical Education and Research, 18 May 2017,

www.mayoclinic.org/diseases-conditions/gastritis/symptoms-causes/syc-20355807.

Sandhya Pruthi, M.D. Ulcerative Colitis. Mayo Clinic, Mayo Foundation for Medical Education and Research, 28 July 2017,

www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes/syc-20353326.

Ulcerative Colitis. National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human

Services, 1 Sept. 2014, www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis.