NUT 4700 MNT I

Case Study 1: Malnutrition and Depression

Case Study 1 Questions Name: Katherine Ventura Section:002

1. Calculations:
a. BEE (using Mifflin St Jeor and Harris Benedict- compare the results)
Harris Benedict: 66+(13.7 * 65.91) + (5 * 180.34) (6.8 * 80)
=1326.667 * 1.2 (sedentary) =1592.00

Mifflin St Jeor: (9.99 * 65.91) + (6.25 * 180.34) (4.92 * 80) + 5
=1387.125 * 1.2 (sedentary) =1664.55

These calculations have provided very similar numbers. Keeping in mind
that these numbers only represent the number of calories my patient needs
to stay alive, I would say the range between these two data sets would be
1500-1700.
b. I would like for this patient to try to gain one pound a week for a couple of
months to replete his weight stores. Since I know that 3500 calories is an
approximate figure for the additional number of calories needed to gain
one pound, Im going to suggest that this patient consume an additional
500 calories each day. This will allow for him to gain one pound each
week. Therefore, the calorie range to replete his weight is 2000-2200.

c. Protein needs 1-1.2g/kg my patient weighs 65.91 kg, therefore his
protein intake should be 66-79 grams.
d. Fluid needs 30 ml/kg my patient weights 65.91 kg, therefore his fluid
intake should be 1977 ml or about 2 liters of fluid.
e. Ideal body weight 106 + (6*11) +/- 10% = 172 +/- 10%
f. Percent ideal body weight 145/172 = 84.3%
145-170/170 = -14.7% weight change
g. Percent usual body weight 145/170 = 85.3%
Calculations from (f) and (g) both indicate that the patient is mildly
underweight.
h. BMI 20.2
This BMI is in the healthy range, but his body weight percentages indicate
otherwise. This BMI is probably not a good number to work with in this
situation knowing that the patient has lost twenty five pounds in two
months.


2. What do MLs BMI and percent weight change indicate about his nutritional
status?

The patients BMI indicates that he is within a normal weight range while his
percent weight change shows he is mildly underweight. Considering the large
amount (twenty five pounds) of weight he has lost in two months, the percent
weight change evaluation provides a more accurate picture of how this patient is
presenting.


3. What nutrition-related issues do his lab values indicate?
The lab data indicated that his albumin and hematocrit were both low and his
hemoglobin was slightly low as well. These markers are good to keep in mind,
but can be misleading. The patient has already indicated he is depressed which
could affect these values significantly. All three of these lab values tend to drop
when patients are stressed.

4. Would a functional assessment of this patient yield any extra valuable
information? Justify your answer.
A functional assessment could possibly yield valuable information. Since I have
already found that he is mildly underweight, a functional assessment could help
me determine if he is malnourished. By testing his hand grip strength and feeling
for wasting muscle tissue, I could possibly build a diagnosis for malnutrition.
With just the data from his current weight loss I cannot diagnose him; a
malnutrition diagnosis requires more than just a weight change. I have already
determined that this patient is not consuming enough protein, and he claims to be
fatigued as well, so it is possible he is malnourished. These points individually
dont indicate malnutrition, but could be contributing factors so it is important to
further investigate.

5. What medical, environmental, and social factors have led to nutritional problems
in this patient?
Medical: He is on four medications currently and may be experiencing food/drug
interaction problems. His iron supplements would compete for absorption with
calcium in his diet, which is of large concern since he has osteoporosis. His anti-
depressant medication could make it harder for him to absorb certain amino acids.
This isnt of large concern right now, but something to consider as we try to
increase his protein intake. His laxatives could also be interfering with the
majority of his medications as it reduces transit time. A possible intervention
could be to increase his fiber intake and decrease his laxative doses. Something
else to consider is that the patient doesnt report having drank any water. Some of
his medications may work better when taken with water; he may want to add
water to his diet around the times he takes his medications. Lastly, since he self-
medicates with Ibuprofen quite a bit he could potentially get a GI bleed.

Environmental: He is living in a large house alone is and eighty years old. There
are many things to consider in this patients situation. He is most likely not
driving as he mentioned a transportation service took him to his doctors
appointment. He may not be able to go out and get groceries even when he does
feel better. If he stays in his house, he may need to set up a grocery delivery
service. If he is still going up and down the stairs in his house he could be in
danger of agitating his hips (that could still be healing) or further exhausting
himself. There is also no one at home or living in the area that assists him with
everyday activities.

Social: His wife recently passed away. He is now possibly stressed and depressed
which could be altering his lab values. Also, she was responsible for buying
groceries and cooking the meals for him. He lives alone and does not interact
with others or do his usual activities/outings (ie-going to church) which could
contribute to his depression.

6. What general conclusions can you draw regarding the adequacy of his current
diet?
A few general conclusions I notice about his diet are:
Quite a few simple sugars
No water
No fruits
No veggies
No multi-vitamin no calcium
Low Protein
Possibly high sodium

7. How can MLs diet be improved to meet his energy requirements, achieve weight
gain, and relieve constipation? Plan a 1 day menu with specific amounts of foods
and times to eat that would improve MLs nutritional status.

Breakfast:
1 cup of coffee
1 slice of whole grain toast
2 tbl jelly
1-2 cups fruit of his choice (not bananas as they may worsen constipation)
1 serving of oatmeal (fruit could be mixed in or served on the side)
cup yogurt
8 oz water
Lunch:
2 butter cookies
Turkey and cheese sandwich on whole grain (lettuce and tomato too)
Spinach and strawberry salad
1 tbls dressing of choice
8 oz water
Dinner:
1 cup of coffee
2 hard boiled eggs
2 oz sliced cheese
Wheat crackers
2 sticks celery
2 tbls peanut butter
8 oz water
Dessert:
6 oz milk
2 butter cookies