UCONN ADIME TEMPLATE Student Name: Scarlett Ball Pt initials: ER

ADIME- Scarlett Ball

(Points
10 A: (Assessment)

Age: 67 Gender Male Admission- 3/22/23

Pt chief complaint, admit signs and symptoms, MD admit diagnosis for pt

Patient E.R. was admitted to the hospital on 3/22/23 for surgical treatment of early-stage lung cancer. He
was recently diagnosed with lower left squamous carcinoma.

Treatments (interventions)/Therapies; i.e. respiratory therapy, IV replacement, PT/OT/SLP, chemo,

radiation, dialysis, CT scan, EGD, surgeries, and how it relates to your patient’s nutritional status

Patient underwent a lower left lobectomy for left lung cancer. The patient is given Tylenol and
Oxycodone as needed for pain. Lastly, ER is being monitored for strict input and output

PMH (in order of importance)

1. Hepatic Cirrhosis: Chronic liver damage from various causes leads to scarring and liver failure.
2. Chronic Pancreatitis: the pancreas (a small organ located behind the stomach and below the
ribcage) becomes permanently damaged from inflammation
3. Chronic Kidney Disease (CKD): a condition in which the kidneys are damaged and cannot filter
blood as well as they should.
4. Hypothyroid: when the thyroid gland doesn't make enough thyroid hormones to meet your body’s
needs.
5. Nephrolithiasis: Kidney stones are hard deposits of minerals and acid salts that stick together in
concentrated urine. A small, hard deposit forms in the kidneys and is often painful when passed.
6. Gastroesophageal Reflex Disease (GERD): a chronic disease that occurs when stomach acid or bile
flows into the food pipe and irritates the lining.

Ht: 6’2” (74 inches) Current/admit Wt: 147lbs (66.7kg) IBW: 184 lbs (83.5.kg)

UBW (if different): Back in 2018, he weighed 164 lbs

BMI and BMI classification: 18.9-> normal weight, but on the lower end

History of Weight Changes (Include the amount, period of time, voluntary or involuntary, % of original
weight)

7/16/18 - 164 bs (voluntary)

9/7/18 - 158 lbs (involuntary) = -3.7%of original weight

5/13/21 - 152 lbs (involuntary) = -7.3.% of original weight

11/3/22 - 149 lbs (involuntary)= -9.1% of original weight

12/19/22 - 143 lbs (involuntary) = -12.8% of original weight

2/22/23- 147 lbs (involuntary) = -10.1% of original weight

3/23/23 = 148 (involuntary)= -9.8% of original weight

UCONN ADIME TEMPLATE Student Name: Scarlett Ball Pt initials: ER

Nutritional Requirements:

kcal: Mifflin St Jeor X injury factor (screen grab)

1,913 kcal for maintenance +500 to return to IBW of

184 lbs (83.5.kg)

wt you are using for calculations

kcal/kg =2,000 kcal - 2,335kcal

30-35 kcal/kg

30 kcal*66.7kg = 2,000kcal

35 kcal*66.7kg = 2,335 kcal

Protein g/kg = 100 g

1.5 g * 66.7kg = 100 kg of Protein

Fluid = 2,220mL

1mL x 2,220l = 2,220 mL

5 Diet Order: (Current and others since admitting in chronological order)

E.R as of 3/22/23 was put on a consistent carbohydrate (diabetic) diet of 250 grams a day/ regular texture,
thin liquids.

Assessment of the appropriateness of current diet order:

The current diet order is inappropriate because there was only one >POCT finger 180. This one high
glucose value could have been because of the corticosteroid (decadron) he was on. Steroids are known
to increase blood sugar in the body and once he stopped taking the decadron his blood sugar went back
to normal levels. Also, the patient said he did not have Diabetes. Therefore, I would put him on a
high-calorie and high-protein diet since he just had the removal of his left lobe. He needs high calories to
gain the lost weight and high protein to recover from surgery and heal.
UCONN ADIME TEMPLATE Student Name: Scarlett Ball Pt initials: ER

5 Labs: Explain relevant lab values

E.R.’s BUN and Creatinine levels are high since E.R. suffers from CKD. BUN and creatinine levels are high
in the blood when the kidneys cannot work properly and cannot excrete them out of the body. E.R.’s GFR
is low since he suffers from CKD. E.R.’s A.D.’s hematocrit, hemoglobin, RBC, and MCHC are low, which
makes sense since he just underwent lower left lobe surgery for lung cancer and should return to normal
in the next week or two. However, doctors should keep an eye on out. E.R.’s POCT glucose level was high
because of stress and could have been due to the decadron spiking his blood sugar. Once E.R. was taken
off the decadron, his POCT glucose values went back to normal.

Name of Lab Normal Range Patients Value/s Date/s

BUN 8-24 mg/dL 30 3/23
Creatinine 0.60-1.20 1.90 3/23
mg/dL
Hematocrit/ 40-52%/ 34.4/ 10.2 3/23
Hemoglobin 13.0-18g/dL
eGFR >60 mL/min 38 3/23
RBC 4.40-5.90 uL 4.14 3/23
MCHC 32-36 g/dL 29.7 3/23
POCT GLucose 70-100 mg/dL >180 3/22

5 Meds, pertinent Drug/Nutrient Interaction information related to admit dx and nutrition intervention – use
shared drug file
DRUG NAME CATEGORY how it works, why Main side effects to look for,
generic (Brand) /when use food/drug interactions….
Acetaminophen Pain reliever Pain reliever, fever N/V/D, loss of appetite | Omega-3,
reducer Vitamin B-12, C, D

Gabapectin anti-epileptic/ used to treat nerve dizziness/ drowsiness, hives, difficulty

anticonvulsant pain and used to breathing, anxiety, panic attacks,
treat seizures fever, chills, headache, tremors,
trouble speaking, n/v

Heparin (porcine) anti-coagulant an anticoagulant N/V, shortness of breath, dizziness,

(blood thinner) that severe pain, bleeding or bruising
prevents the
formation of blood
clots.

Levothyroxine thyroid Levothyroxine is a fast or irregular heartbeats;

(Euthyrox) thyroid medicine chest pain, pain spreading to your jaw
that replaces a or shoulder; shortness of breath;
hormone normally fever, hot flashes, sweating;
produced by your tremors, or if you feel unusually cold;
thyroid gland to
UCONN ADIME TEMPLATE Student Name: Scarlett Ball Pt initials: ER

regulate the body's weakness, tiredness, sleep problems

energy and (insomnia); memory problems, feeling
metabolism. depressed or irritable;
headache, leg cramps, muscle aches;
feeling nervous or irritable;
dryness of your skin or hair, hair loss;
irregular menstrual periods; or
vomiting, diarrhea, appetite changes,
weight changes

Pantoprazole Proton pump a proton pump headache, dizziness, stomach pain,

inhibitor inhibitor that nausea, and vomiting
decreases the
amount of acid
produced in the
stomach.

Tamsulosin alpha blocker relaxes the muscles low blood pressure; dizziness,
in the prostate and drowsiness, weakness; nausea,
bladder neck, diarrhea; headache, chest pain;
making it easier to abnormal ejaculation, decreased
urinate. amount of semen; back pain; blurred
vision; tooth problems; fever, chills,
body aches, flu symptoms; runny or
stuffy nose, sinus pain, sore throat,
cough; sleep problems (insomnia); or
decreased interest in sex.

Decadron steroid that prevents the muscle tightness, weakness, or limp

release of feeling; blurred vision, tunnel vision,
substances in the eye pain, or seeing halos around
body that cause lights; shortness of breath (even with
inflammation mild exertion), swelling, rapid weight
gain;severe depression, unusual
thoughts or behavior;a seizure
(convulsions);
bloody or tarry stools, coughing up
blood;fast or slow heart rate, weak
pulse; pancreatitis--severe pain in
your upper stomach spreading to your
back, nausea and vomiting;low
potassium level--leg cramps,
constipation, irregular heartbeats,
fluttering in your chest, increased
thirst or urination, numbness or
tingling; or
increased blood pressure--severe
headache, blurred vision, pounding in
your neck or ears, anxiety, nosebleed
UCONN ADIME TEMPLATE Student Name: Scarlett Ball Pt initials: ER

5 Nutrition Focused Physical Findings: (physical appearance, muscle and fat wasting, swallow function,
appetite)

During the visit E.R was alert and sitting in his chair watching tv and on his phone. He was missing teeth.
However, he did not have his dentures in. His lips, tongue, and gums looked normal. He had a little bit of
muscle wasting. He told me he had a decreased appetite and weight loss after discovering he had cancer.
He was hoping for his appetite to get better after the surgery. I saw that he ate his lunch except for the
string beans since they were hard. Without having teeth, it is hard for him to eat. He ate 66% of his
breakfast and 90% of his lunch.

5 Pertinent Social Hx: (education, occupation, social, economic status, ethnic or religious influence,
psychological background) Focus on factors that affect eating habits and ability to procure, store, and
prepare food (food insecurity).

A.D. is divorced and lives in an apartment by himself. Before March 1st, he lived with his daughter. His
ethnicity is Hispanic/Latino, which influences his eating of rice and beans. He has smoked 0.5 packs of
cigarettes daily for the past 40 years. He quit heroin back in 2015 and occasionally smokes marijuana. His
mother died of a heart attack and hypertension. Also, his father died of liver cancer. In his chart, it says
he has anxiety about his living situation, suffers from chronic joint and back pain, and complains of
headaches.

5 Nutrition History, Diet PTA (include quality of intake regarding meeting needs, medication/herbal/vitamin
supplement intake, knowledge of diet, food beliefs, and physical activity)

Patient eats about 75% of his trays. Regarding quality intake, E.R. s not meeting his nutritional needs, as
evidenced by his decreased appetite and weight loss. He is knowledgeable about his diet and does not
like to cook with a lot of salt, and does not like to eat junk food. Before his lung cancer diagnosis, he ate
two meals a day. For breakfast, he told me he likes to have an omelet with coffee, and for dinner, he eats
steak, rice, and beans. He used to take a lot of supplements, but when he was trying to figure out his
kidney stone issue, his doctor told him to stop. In the chart patient was put on a diabetic diet; however,
E.R. confirmed to me that he does not have diabetes.

5 Summary of Current Intake ( Nutritional Adequacy of the patient’s most recent nutrient intake via 24-hour
recall or intake documented from oral, tube feeding, IV. Intake information may be obtained from the
patient, family, diet order, or nursing notes. Please assess the adequacy of intake regarding protein,
carbohydrate, fat, calorie, vitamins, minerals, and fluids for your patient.)

Since E.R. was admitted to the hospital for his surgery, he has had an inadequate oral intake and has
been eating 75% of his trays. E.R. is not meeting his daily needs of 2,200 kcal a day. Since E.R. was
diagnosed with lung cancer, he has had an inadequate intake of protein, carbohydrates, fat, and calories,
which could be due to depression and/or lung cancer, causing a lack of appetite and difficulty chewing/
swallowing. Also, unintentional weight loss occurred due to inadequate diet and not meeting calorie
needs.

5 D (Diagnosis) PES, Nutritional Problem/Diagnosis Related To Etiology As evidenced By Signs/Symptoms –

EACH TIME GO TO eNCPT and review your diagnosis term etiology and signs/symptoms
UCONN ADIME TEMPLATE Student Name: Scarlett Ball Pt initials: ER

Inadequate oral intake related to lung cancer diagnosis as evidenced by losing weight without trying and
decreased appetite.

15 I (Intervention) is based on your Nutritional Diagnosis Etiology and must determine patient-focused
expected outcomes for each nutrition diagnosis
● Food and/or Nutrient Delivery (meals, snacks, enteral and/or parenteral feeding; supplements – as in
commercial, food/drink based, or vitamin/mineral)

Patients should meet a daily calorie intake of 2,220 kcal and 100g of protein. He should be taken off the
consistent carb (diabetic) diet since E.R. told me he does not have diabetes. Therefore, since E.R. just
underwent surgery to remove the lower left lobe in his lung, I would put him on a High-Calorie, High
Protein diet to heal the lung as fast as possible. With Mifflin St. Jeor, I calculated a 1,900 kcal however, with
a 2,200 kcal diet, E.R. will increase calorie intake by 300 calories a day which should help gain over ½ a
pound per week. I want him to continue this diet until he reaches his normal weight back in 2018, which
was around 164 lbs. I will follow up after one month of this 2,200 kcal diet to see how his appetite is and to
see if he is gaining weight. I calculated his protein to be 100 grams with a 1.5g/kg protein requirement
because protein is essential for the healing of the lung.

● Nutrition Education (purpose; priority modifications; survival info; nutrition relationship to health and
disease; recommended modifications)

Due to his removal of the lower left lobe, I would educate him on the importance of eating a high-protein
diet to heal his left lung. Patient E.R. should eat a high-protein diet to heal and recover from surgery. Also,
the patient should eat a high-caloric diet to regain energy and reduce unintentional weight loss. After
speaking with E.R., I returned to the room and provided him with Nutrition Education on a High Protein,
High-Calorie diet, which he said he would read.

● Coordination of Nutrition Care (team meeting; referral to RD with different expertise; collaboration
with other providers; referral to community agencies or programs)

I would defer him to PT as I feel like there is an activity barrier suspected. is super important that he
exercises as it can reduce breathlessness, control weight, improve his mood, and increases muscle
strength. Also, I would refer E.R. to a smoking cessation program to deter him from smoking again. The
smoking likely gave him lung cancer, so I hope he doesn’t continue after he gets out of the hospital.

10 M/E (Monitoring and Evaluation) Nutrition care indicators that will reflect a change in nutrition care
provided. is based on your Nutritional Diagnosis signs and symptoms of your AEB. You will not have all of
these.
● Food/Nutrition Related Outcomes
o Increase calories to 2,200 kcal a day for adequate oral intake and monitor through calorie
countting
o Increase protein to a 100g of protein to heal lower left lobe of lung and monitor through
calorie counting
o Consume at least 75% of high protein, high calorie meals

● Anthropometric Measurement Outcomes (Hit, Wt, BMI) uncommon to see a change between
inpatient assessments
o 1-month assessment (at least 1-2 pounds gained)
o Monitor muscle mass at 1-month assessment
UCONN ADIME TEMPLATE Student Name: Scarlett Ball Pt initials: ER

o Monitor BMI at one month assessment

● Biochemical Data, Medical Tests, and Procedure Outcomes (glucose, electrolytes, gastric emptying)
Want all of these values to be within normal range
o Monitor Creatinine at one month follow up
o Monitor POCT glucose to make sure he does not have diabetes at one month follow up
● Nutrition-Focused Physical Findings Outcomes ( appetite, swallow function more uncommon
change in muscle/fat wasting)
o Increased appetite
o Increase muscle mass
o Increase in weight (to gain back that involuntary weight loss)
o Monitor next finger stick, since the last one was high
● Nutrition Education Outcomes Knowledge (what will your patient tell you in the teach-back?)

o Patients is able to name three lean proteins.

Meal Plan
5 1. For current Dx explain if the patient's diet is appropriate: Foods Allowed, Foods Not Allowed, Diet
Instruction Materials if appropriate. Describe in your own words the rationale for diet
restrictions/modifications and what changes you would make if needed.

The patient’s current diet prescription is a consistent carbohydrate (diabetic) diet of 250 grams a
day/with regular texture and thin liquids. However, he told me he does not have diabetes. Therefore,
since he is just going through surgery to remove cancer in the lower left lobe of his lung, I would put E.R.
on a high-calorie and high-protein diet. E.R.’s daily intake should be 2,200 kcal. The breakdown is 110g of
protein, 73g of fat, and 275g of carbohydrates. In other words, 20% comes from protein, 30% from fat,
and 50% from carbs. This diet will assist in E.R. gaining weight and muscle so that E.R. can heal and
10 repair post-surgery. E.R. lost since appetite when diagnosed with lung cancer. The emphasis of E.R.’s diet
should be rich in lean protein, whole grains, fruits, vegetables, and beans. Foods that should be avoided
for E.R’s GERD are fatty or fried foods, spicy or minty foods, foods with a tomato base, such as pizza,
chili, pasta sauce or salsa, citrus fruits, onions, garlic, chocolate, and alcohol. Foods that should be
avoided for his kidney stones are oxalate-rich foods such as beets, chocolate, spinach, rhubarb, tea, and
nuts. For cancer prevention, he should also avoid highly processed foods and other processed foods that
are high in fat, starches, and sugars, red meat, sugar-sweetened beverages, alcohol, and supplements.

2. Menu Plan or Nutrition Support Regimen for Discharge “Diet “Must be of your design. Include
pertinent nutrient analysis; calories, macronutrients, fluid, and pertinent vitamins/minerals totaled
by meal and snack and for the day. Nutrient analysis may be computed with Cronometer,
UCONN ADIME TEMPLATE Student Name: Scarlett Ball Pt initials: ER

Nutribase, ADA exchanges.

UCONN ADIME TEMPLATE Student Name: Scarlett Ball Pt initials: ER
UCONN ADIME TEMPLATE Student Name: Scarlett Ball Pt initials: ER

Total Water Intake- 1,200 mL of Water

5 References - must follow Academy formatting for references – see HuskyCT

1. Academy of Nutrition and Dietetics. Nutrition Care Manual. Nutrition During And After Cancer
Treatment https://www.nutritioncaremanual.org/client_ed.cfm?ncm_client_ed_id=81. Accessed
March 26, 2023.
2. Academy of Nutrition and Dietetics. Nutrition Care Manual. High-Calorie, High-Protein Nutrition
Therapy https://www.nutritioncaremanual.org/client_ed.cfm?ncm_client_ed_id=509. Accessed
March 26, 2023.
3. Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics
Language for Nutrition Care. http://www.ncpro.org. Accessed February 13, 202].
4. Tamusolsin uses Side Effects & Warnings. Drugs.com.
https://www.drugs.com/mtm/docusate-and-senna.html. Accessed March 26, 2023.
5. St Vincent's Heart Health. (n.d.). After Lung Surgery. St Vincent's Lung Health. Retrieved March 26,
2023, from
https://www.svhlunghealth.com.au/rehabilitation/after-lung-surgery#:~:text=Exercising%20will%2
0help%20to%20speed,gradually%20increase%20length%20and%20intensity.

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