Nutrition Care Process: Iron Deficiency Anemia

28 y/o Hispanic male. Client wants to “improve his diet to support his health”.
Medical/Clinical History: Diagnosed of gastritis and bleeding ulcer 6 mo. ago, due to
chronic NSAID use (from sports injury).
Anthropometry: Height: 180.3 cm. Weight: 80.9 kg. BMI is normal (24.89; normal:
18.5-24.9). Weight is normal (IBW 78.18 kg +/- 10%;80.9 is WNL). Stable weight
management.
Laboratory: Hct (41%; normal: 42-52%); MCHC (31 g/dL; normal: 32-36 g/dL);
Total cholesterol (205 mg/dL; normal: <200mg/dL). Ferritin is on the low range of
normal (60 ng/ML; normal: >70 ng/mL). Lost 25 lbs with help of a nutritionist.
Social History: Single, no children, and no family members nearby. High-stress job.
Owns home.
Diet: (5:00 AM) 2% fat milk (taken with iron supplement) 1 cup
Before workout: Water
(6:30 AM) Breakfast: Cottage cheese, 1% fat, topped with:

Assessment o Fresh banana

o Corn flakes, Erewhonian brand
Orange juice
Water
(7:15 AM) Driving to work: Caffe latte with whole milk, Starbucks
(1:00 PM) Lunch: Home-made Fajita
o Tortilla, corn, 7”, Mission Brand
o Cheese, Monterey jack, shredded
o Red bell peppers, sautéed
o Light sour cream
o Guacamole, Trader Joe’s
Large fresh apple
Water

Diagnosis Food-Medication Interaction (Iron-Calcium) [NC-2.3] related to limited knowledge of

dairy interaction with iron supplement consumption as evidenced by food record and
 suboptimal Hct 41% (normal: 42-52%) and MCHC 31 g/dL(normal: 32-36 g/dL),
despite reported supplementation of 20 mg/d.
Intervention 1. Discuss calcium’s role in the inhibition of iron intake and its relationship to
iron status and anemia. Discuss ideas about ways to reduce nausea by
substituting non-calcium-rich foods for his current choices. Educate the client
about foods that may increase iron absorption. Suggest orange juice as an
appropriate substitute for milk. Vitamin C will increase absorption of iron.

2. Pre-workout Snack (5:00 AM)

o 1 slice whole grain bread, toasted
o 1 TB chunky peanut butter
o 6 oz orange juice
o 8 oz water

Breakfast (6:30 AM)

o 1.5 cup 1% cottage cheese
o 1 medium banana, sliced
o 1 cup corn flakes, Erewhonian brand
o 1 large orange
o 12 oz water
Morning Snack (7:15 AM)
o Coffee latte w/ 2% milk, Starbucks
o 1 oz walnuts
o Lunch (1 PM)
o Home-made fajita:
o 2 tortillas, corn 7”
o .5 cup low fat Monterey cheese, shredded
o 1 cup bell peppers, sauteed
o 1 cup yellow onions, sauteed
o 2 oz light sour cream
o .25 cup guacamole
o 4 oz flank steak, lean, brld
o 1 large apple
o 16 oz water

Afternoon Snack (5:00 PM)

o 15 mini rice cakes, BBQ, Quaker
o 1 red grapefruits
o 16 oz water
Dinner (8:00 PM)
o 3 cups vegetable fried rice, frozen
o 1 cup zucchini squash slices w/skin, drnd
o .5 Tb butter
 o .5 cup spinach, ckd
o 8 oz water
Evening Snack (10:00 PM)
o 1 cup peach sorbet, fat free (taken w/iron supplement)
o 16 oz water

At the end of today’s session, the client will be able to successfully answer questions
about calcium’s inhibitory effects on iron absorption and will be able to identify
appropriate food choices to substitute in place of his current choices.
Monitoring
and Evaluation
Follow up in 2 weeks. Follow up activities: Will assess client’s success/failure in
implementing dietary changes. Were the substitutions for dairy as effective in
relieving nausea, or has his nausea increased?