Scenario 3: chapter 27

A 42-year-old female who presents with acute onset of epigastric abdominal pain associated with
nausea and bilious vomiting, poor appetite, and 20-pound (9-kg) unintentional weight loss over
the past 3 months.

Nutrition Assessment

 Anthropometrics: Ht: 162.5 cm (64 inches); Wt: 72.7 kg (160 lb); BMI:?
 Usual body weight: 81.8 kg (180 lbs); weight change: calculate it?
 Past medical history is significant for type I DM, GERD, gastroparesis, hypertension,
chronic low back pain, and recent back surgery 3 months ago. She was discharged on
narcotics, and then was recently hospitalized for similar symptoms that were attributed to
diabetic gastro-paresis exacerbated by narcotics use.

• Her medications on admission include insulin, Zofran, Prilosec, Reglan, lisinopril, Ultram.

• Oral intake has gradually decreased over the last 3 months to sips of liquids (water, soup, tea),
and toast or crackers for the past 2 weeks. Upon further questioning, Jane reports frequent
hypoglycemia after meals, early satiety, chronic constipation, and often wakes up in the morning
feeling full. She has persistent epi-gastric abdominal pain accompanied by vomiting.

• Nutrition-focused physical examination (NFPE) reveals the following:

No evidence of muscle loss; stomach is smaller per patient report but otherwise no visible
evidence of fat loss; no upper or lower extremity edema. Tongue is beefy red and swollen for the
past few weeks).

• Functional capacity: Little energy or motivation to do anything for past 3 months. Dizzy and
light headed for past 1 week.

• Laboratory data:

I. Hb A1C (glycosylated hemoglobin) level: 9.5% (high)

II. blood pressure: 178/95 (high),
III. blood glucose: 293 mg/dl (high)

Nutrition Diagnostic Statements (PES Statements) ?

Nutrition Interventions

1) What would you estimate to be her daily energy and protein requirements?

2) What would you work out for timing and size of her meals?

3) Would you recommend a trial of oral nutrition supplements?

4) In educating her on dietary guidelines for DM and gastroparesis, what would you discuss with
her?

5) What concerns would you have related to her use of antiemetics or prokinetic agents.

6) Would you recommend any nutritional supplements for her. Which nutrients would concern
you?

7) What does Nutrition-focused physical examination (NFPE) reveals?

Nutrition Monitoring and Evaluation

1) What would you monitor during your follow up visits with patient to ensure that her nutrition
goals are being met?