NUTRITION CARE

PLAN
Natalie Ranelli
Diet 3155
Patient Overview
◦ Admitted: March 20th 2016 ◦ Sepsis
◦ Obesity
◦ Seen: October 1st ◦ Type 2 diabetes
◦ 86 year old, widowed female ◦ Hypertension
◦ Anxiety
◦ Readmitted: June 19th following ◦ NSTEMI
hospitalization of AKI and UTI
◦ Primary diagnosis: acute kidney
failure
◦ Also suffering from:

https://www.istockphoto.com/illustrations/family-tree
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Medical History
◦Acute Kidney Failure
◦Sepsis due to E. Coli
◦UTI
◦Acute cystitis wit hematuria
◦Anemia
◦NSTEMI
◦Atherosclerotic heart disease
◦Cerebral infarction
◦Occlusion and stenosis of carotid arteriesanxiety and depressed mood
◦Hypertension
◦Type 2 diabetes mellitus
◦Long term use of insulin
• Abnormalities of gait and reduced
mobility
• Morbid obesity due to excess calories
• Paroxysmal atrial fibrillation
• GERD
• Hyperlipidemia
• Dry eye syndrome
• Adjustment disorder with mixed
• Anxiety disorder
• Dysphagia, oropharyngeal phase
• Systolic (congestive) heart failure
 Acute Kidney Failure
◦ kidney fails to eliminate
excess salts, fluids, and
waste materials from the
blood

https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521
 Type 2 Diabetes
◦ Insulin resistance
◦ Related complications

https://www.thermofisher.com/blog/proteomics/type-2-diabetes-metabolomics-reveals-lipid-dysregulation/
https://www.healthline.com/health/diabetes/effects-on-body
 Obesity
◦ Morbid obesity due to
excess calories
◦ Related conditions
◦ Many factors

https://www.novonordisk.com/patients/obesity/understanding-obesity.html
https://www.acc.org/latest-in-cardiology/articles/2018/07/06/12/42/cover-story-obesity-and-cardiovascular-disease-risk
 Heart Conditions
◦ non-ST elevation (NSTEMI)
myocardial infarction
◦ Atherosclerotic heart disease of
native coronary artery with
unspecified angina pectoris
◦ Occlusion and stenosis of bilateral
carotid arteries
◦ Essential (primary) hypertension
◦ Paroxysmal atrial fibrillation
◦ Hyperlipidemia

https://stock.adobe.com/images/ecg-of-non-st-elevation-myocardial-infarction-nstemi-and-detail-of-ecg-p-wave-pr-segment-pr-interval-qrs-complex-qt-interval-st-depress-t-wave-acute-coronary-syndrome-angina-pectoris/107601112
https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/syc-20350613
https://medical.andonline.com/more-than-a-measurement/hypertension
https://heartandhealth.com/what-is-hyperlipidemia/
 Dysphagia, oropharyngeal phase
◦ Problems in the
oral preparatory
phase, oral phase,
and pharyngeal
phase
◦ The current diet
orders reflect this

https://www.semanticscholar.org/paper/Cough-and-Aspiration-of-Food-and-Liquids-Due-to-Hammond/543e17588a7577be3ee9ad25e0010b2e124a3403/figure/1
Anthropometric Overview
◦ Height: 5’2”
◦ Weight: 282 lbs
◦ Significant increase
◦ Social Factors
◦ BMI: 51.6
◦ Nutrition Based Physical Exam
◦ Long term and short term goals
 Medications
◦ Acetaminophen ◦ Ear Wax Removal Drops ◦ Milk of Magnesia
◦ Allopurinol ◦ Enema (sodium phosphates ◦ multivitamin with minerals
◦ Anti-Diarrheal (loperamide) ◦ Gabapentin ◦ Pantoprazole
◦ Ayr Saline (sodium chloride- ◦ GlucaGen HypoKit ◦ Simethicone
aloe vera) ◦ Insta-Glucose (with dextrin) ◦ Tylenol-Codeine
◦ Bisac-Evac (bisacodyl)
◦ Levemir FlexTouch U-100 ◦ Vitamin C
◦ Bumetanide Insulin ◦ Xarelto
◦ Cholecalciferol (vitamin D3) ◦ Lisinopril
◦ Clonazepam ◦ Mapap Extra Strength
◦ Cymbalta ◦ metoprolol tartrate

https://chicago.suntimes.com/2019/8/29/20828923/shopping-abroad-cheaper-medication-what-you-need-to-know
https://www.commonwealthfund.org/publications/issue-briefs/2017/oct/paying-prescription-drugs-around-world-why-us-outlier
 Treatments and Therapies
◦ PT/OT
◦ Speech Therapy
◦ Glasses
◦ Chronic ear wax removal
◦ Upper set of dentures
◦ Wheelchair
◦ Needs aid for self-care

https://www.istockphoto.com/illustrations/physical-therapist
https://www.researchgate.net/figure/Four-swallowing-phases-a-oral-preparatory-phase-b-oral-transit-phase-c_fig1_282038340
https://www.vectorstock.com/royalty-free-vector/flat-cartoon-lightweight-metal-wheelchair-vector-17910079
 Biochemical Data: Areas of Concern
  5/31/19 6/28/19 7/06/19 8/23/19 9/22/19 9/30/19 Normal
Sodium 136 141 140 139   136 133-145
mmol/L
Potassium 5.0   5.4 4.2   4.8 3.3-5.1 mmol/L
◦ Sodium
◦ Potassium Chloride 96     98   98 96-180 mmol/L

◦ BUN BUN 62 72 41 59 79   10-24 mg/dL

◦ Creatinine Creatinine 1.5 1.8 1.0 1.2 1.5   0.7-1.5 mg/dL

◦ GFR Glucose   124 108 114 108   70-120

GFR 36 27 51 47 33   60-120
◦ Hemoglobin Hemoglobin         10.2   11.7-15.7 g/dL

◦ Hematocrit Hematocrit         31.8   35-46%

◦ RBC RBC         3.39   4.0-5.4 Mil/uL

WBC         5.9   4-11 Thou/uL

 Dietary Data
◦ Current Diet order:
◦ no salt added
◦ carbohydrate
controlled
◦ 1500 calories
◦ Whole with chopped
raw fruits and
vegetables
◦ Finicky Eater

https://blog.ohiohealth.com/dash-diet-lower-blood-pressure/
https://online.jwu.edu/blog/interviews-and-thank-you-letters-go-together-peanut-butter-jelly
 Dietary Needs Calculations
◦Calories: ◦Proteins
◦ 2,177.6 kcal/day ◦ 1.0g/kg ◦Pertinent
◦ Weight loss: 1,677.7 ◦ 127.9 g/day
kcal/day
Nutrients
◦ 511.65 kcal/day
◦ Potassium: less then
◦ 30% 2,000 mg per day
◦ Sodium: less than
◦Carbohydrates: 1,500 mg/day
◦50% ◦Fats: ◦ Cholesterol: 200
◦ 838.8 kcal/day ◦20% mg/day
◦ 209.7 g/day ◦ 327.13 kcal/day
◦ 36.25g/day
◦Fluids
Nutritional Status and Assessment
◦ Current needs being met
◦ Lower calorie, carbohydrate controlled, no salt added
◦ Promotion of fluid intake and vitamin supplementation
◦ Chopped raw fruits and vegetables
◦ Nutrition education
◦ Common mistakes
◦ Experimentation and variety of options

https://fit-trim.com/
Sample Menu Nutrient Unit Oatmeal, Scramble peanut cranberry low Total
4 oz d egg, 1 butter, juice, fat
large no unsweetened, milk,
◦ Breakfast: sodium, 1 cup 4oz
1 tbsp

Energy kcal 72 91 101 116 50 430

Protein g 2 6 4 1 4 17

Fat g 1 7 8 0 1 17

Carbohydrat g 13 1 4 31 6 55
e
Fiber, total g 2 0 1 0.3 0 3.3
dietary
Sugar totals g 0 1 1 31 6 39

Sodium mg 5 88 10 5 63 171

Potassium mg 7 35 0 195 170 407

Cholesterol mg 0 93 0 0 5 98
Lunch Nutrient Unit Ground Green
Beef, 4 beans, 1
greek
vanilla
white
bread,
carrots, 1
cup cooked
Total

oz cup yogurt, toast, 1

cooked 5.3oz slice

Energy kcal 230 31 80 70 52 463

Protein g 22 2 12 2 1 39

Fat g 15 0 0 1 0 16

Carbohydrat g 0 7 9 14 12 42
e
Fiber, total g 0 4 0 1 3.4 8.4
dietary
Sugar totals g 0 0 7 1 6 14

Sodium mg 56 6 50 140 18 270

Potassium mg 279 183 380 0 480 1322

Cholesterol mg 74.8 0 32 0 0 106.8

Dinner Nutrient Unit Tomato
soup, no
peas, Pork
cooked, Tenderloin,
Total

sodium, 80g 4 oz
8oz
Energy kcal 200 70 120 390

Protein g 2 5 23 30

Fat g 5 1 3 9

Carbohydrat g 38 12 1 51
e
Fiber, total g 0 3 0 3
dietary
Sugar totals g 26 4 1 31

Sodium mg 120 14 60 194

Potassium mg 198 0 160 358

Cholesterol mg 0 0 70 70
 Nutrient Unit Apple, 1 Pudding Cottage Total
medium 0.5 cup cheese, no
Snacks sodium
added, 0.5
cup

Energy kcal 95 80 100 275

Protein g 0 2 15 17
Fat g 0 0 2 2
Carbohydrat g 25 18 7 50
e
Fiber, total g 4 0 0 4
dietary
Sugar totals g 19 19 7 45

Sodium mg 2 80 29.4 111.4

Potassium mg 195 100 194 489
Cholesterol mg 0 0 5 5
Actual vs Recommended
Nutrient Unit Actual Recommended

Energy kcal 1558 1,677.00

Protein g 103 127.9
Fat g 44 36.25
Carbohydrate g 198 209.7

Fiber, total g 18.7 25g

dietary
Sodium mg 746.4 1,200
Potassium mg 2169 2,000mg or less

Cholesterol mg 279.8 200

 Measurable Goals
◦ Consume 75-100% of meals majority (3/4) of the time for a period of 90 days.
◦ Keep blood sugar within a regular reading at majority of readings, for 90 days.
◦ Keep blood pressure within a regular reading at majority of readings, for 90
days.
◦ Track weight daily for a period of 90 days and track gradual weight loss

https://www.inc.com/larry-alton/are-your-goals-actually-working-against-you.html
 PES
◦ Obesity, grade 3, related to physical inactivity and excessive energy intake as
evidenced by a BMI of 51.6, decreased mobility, complications of kidney
failure, history of difficulty managing blood pressure, type 2 diabetes,
hypertension and other heart conditions.

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References
◦ “Drugs by Name, Generic and Brand.” Merck Manuals Professional Edition, Merck & Co.,
Inc., www.merckmanuals.com/professional/resources/brand-names-of-some-commonly-used-drugs.
◦ Escott-Stump, Sylvia. Nutrition and Diagnosis-Related Care. Wolters Kluwer, 2015.
◦ Mahan, L. Kathleen, and Janice L. Raymond. Krause's Food & the Nutrition Care Process.
◦ Elsevier, 2017.
 
THANK YOU.
QUESTIONS?