Erica Cutts

MNT II
ADIME Homework

A:
82 y/o male referred by MD after evaluation of weight loss following a fall and subsequent hip
replacement. Patient lives with wife, who does the cooking, but patient complains of mouth sores
from ill-fitting dentures due to recent weight loss. Patient reports a UBW of 195lbs, with a
current weight of 180lbs. Patient states he wants to get back to golfing regularly, but that he feels
too tired.
Family History: ​Unknown
Diet History: ​Patient states appetite declined after surgery.
CW: ​81.82kg UBW:​ 88.64kg (currently 92.3% of UBW)
Ht: ​187.96cm
BMI:​ 23.15 (normal) Past BMI: ​25.08 (overweight)
% RWC: ​7.69% RWC (severe)
RBW: ​86.4kg % RBW:​ 94.7% RBW
Labs:​ Unknown
Meds:​ Unknown
Estimated Kcal Needs for Wt. Gain: ​2296-2496kcals/day (Mifflin + PA/Stress factor +
200-400kcals for weight gain)
Estimated PRO Needs: ​82g/pro/day (1g/kg body weight)
Estimated Fluid Needs: ​2296-2496mL/day (1mL/kcal)

D:
PES: ​Unintended weight loss (NC-3.2) R/T decreased ability to consume sufficient
energy/nutrients AEB 15lb weight loss in 3 months; 7.69% RWC in 3 months; current BMI
23.15 (normal); past BMI 25.08 (overweight).
PES: ​Biting/chewing difficulty (NC-1.2) R/T recent weight loss AEB mouth sores; 15lb weight
loss in 3 months; 7.69% RWC in 3 months.
PES:​ Physical inactivity (NB-2.1) R/T fatigue and weight loss AEB patient report of fatigue;
recent weight loss of 15 pounds; 7.69% RWC in 3 months.

I:
Goal​: JT will increase calorie intake 200-400 kcals/day via nutritional supplements to support
weight gain of approximately 0.5lbs/week.
Recommendation​: Patient consume 1 nutritional supplement (Boost, Ensure, Carnation
Instant Breakfast, etc) per day to increase calorie intake to achieve weight gain.
Goal​: JT will increase physical activity by 5 minutes every other day to achieve goal of 30
minutes of comfortable physical activity.
Recommendation​: Patient engage in increasing amounts of physical activity (of choice)
until being able to comfortably resume usual activities.

M/E:
Monitor:
1) Keep a 3-day food record for next visit in 2 weeks to monitor caloric intake.
2) Keep physical activity log.
3) Self-monitor mouth sores and ability to eat.
4) Self-monitor and log weekly weight gain
Follow Up:
1) Bi-weekly visits for 1 month for diet, weight, and physical activity check-ins, then once
monthly visits until patient achieves appropriate weight gain.