Pt: CM

A Client Hx Pertinent Labs

 Age: 37 Lab Reference 2/23
 Caucasian Male K+ (mEq/L) 3.5-5.5 5.8 HIGH
 Admitted for Roux-en-Y gastric Glucose (mg/dL) 70-110 145 HIGH
CPK (U/L) 55-170 M 220 HIGH
bypass surgery on 2/24 Cholesterol (mg/dL) 120-199 320 HIGH
 Lifelong obesity HDL-C (mg/dL) >45 M 32 LOW
 R total knee replacement 3 y/a VLDL (mg/dL) 7-32 45 HIGH
LDL (mg/dL) <130 232 HIGH
 Sedentary lifestyle, casually LDL/HDL ratio < 3.55 7.5 HIGH
drinking 2-3 beers per week, no Triglycerides (mg/dL) 40-160 M 245 HIGH
tobacco HbA1c (%) 3.9-5.2 7.2
 T2D, Htn, hyperlipidemia,
osteoarthritis Vitals
 Family history: T2D, CAD, Htn,  Normal temperature and pulse
COPD, osteoporosis  Respiration rate 23 HIGH
Anthropometrics  Blood pressure 135/90
 Ht: 5’10” (178cm)
 Wt: 410# (186 kg) Physical Assessment
 BMI: 58.9 MORBIDLY OBESE  Normal heart, HEENT, Neurologic,
 UBW: 434# (197 kg) Genitalia, Chest/lungs
 IBW (Hamwi): 106lb (10 in x 6lbs)  Extremities: ecchymosis, petechiae
= 166 lbs x 1.10 = 182.6 lbs on lower extremities, 2+ pitting
edema
Medications  Abdomen: obese, rash under
 Metformin 1000 mg BID skinfolds
 35 u Lantus pm
 Lasix 25 mg/day
 Lovastatin 60 mg/day

D Nutrition Diagnosis
 PES#1: Excessive oral intake (NI-2.2) R/T high consumption of foods AEB BMI of
58.9 and 410 lb weight.
 PES#2: Excessive fat intake (NI-5.6.2) R/T consumption of fatty foods AEB
cholesterol level of 320, LDL levels of 232 and triglyceride level of 245

I Intervention
 Food diary and exercise log
  Initiate slow progression of solid food to prevent onset of early and late
dumping syndromes.
 Avoid all simple sugars initially, including in clear liquids. Broth is okay. The
first meals should consist of protein, fat, and complex carbohydrate, with only
one to two food items at a time.
 Avoid dairy products initially.
 Slowly progress to five to six small meals each day. Consume liquids 30
minutes to 1 hour after solid food.
 Lie down after eating.
 If diarrhea occurs add functional fibers to delay gastric emptying.
 Liquid multivitamin and mineral supplements to prevent nutrient deficiency
 Provide nutrition education to promote optimal nutritional intake and
minimize malabsorption and/or maldigestion.
M/E  Review food diary and exercise log
 Monitor and asses weight loss rate, and for symptoms of malabsorption and
steatorrhea
 Monitor hemoglobin, hematocrit, ferritin, serum iron, serum B12 and folate
levels
 Monitor vitamin, mineral and micronutrient levels at risk for deficiency and
osteoporosis
Signature: Annie Lin, CNS