Alzheimers

Disease
Sheri Budge Sotto, Camille Williams,
Alexandra Melendez, Aubrey Burton

What is alzheimer's?
-Progressive, neurodegenerative disease
characterized in the brain by abnormal
clumps of amyloid beta peptide (plaques) and neurofibrillary
tangles that causes loss of connections between neurons in the
brain.
-Named after Alois Alzheimer who clinically described it in 1907

Prevalence
-Most common form of dementia.
-Accounts for 60-80% of all
dementias

Prevalence
-35 million + people have Alzheimer's worldwide
-More than 5 million in the US and will continue to increase
- By 2050, the number of people age 65 and older with Alzheimers disease may nearly
triple, from 5.1 million to a projected 13.8 million in the US

Prevalence
-6th leading cause of death in the US and the third for the elderly behind heart disease
and cancer
-Alzheimer's is the only cause of death among the top 10 in America that cannot be
prevented, cured, or even slowed.
-Life expectancy- varied depending on time of diagnosis, as little as 3-4 years if older than
80 but the younger you are the more time you may have

COST

Etiology
Most important
risk factor is AGE.

Etiology
-Gender: Incidence rate is about the same for both sexes but is 3 times more prevalent in
women
-Genetics: Apolipoprotein-E4
-Familial genes: APP, PS1, PS2
-Family History
-Cardiovascular disease
-Education level
-Social Cognitive engagement
-Trauma Brain Injury

Causal Factors
-Damage to key mitochondrial components
-Oxidative stress/free radicals
-Impaired insulin signaling
-Elevated homocysteine
-Low folate
-High serum cholesterol

Pathophysiology

Cranial Lobes

Temporal Lobe
Pons and
Medulla

Effects of Lesions

Frontal

Loss of smell, visual changes,

motor apraxia

Parietal

Chronic inability to focus

attention

Occipital

Cortical blindness (unawareness

of blindness)

Temporal

Memory and speech impairment,

prone to seizures

Cerebellum

Hydrocephalus quick death

(S/S: trouble with balance,
sleepiness, headache worse
upon waking up)

Pons &
Medulla

Dysfunctions of any of the

cranial nerves; dysregulation of
cardiac/respiratory centers

Parietal Lobe
Occipital
Lobe

Frontal Lobe

Lobe

Cerebellum

Cranial Nerves & Functions

Anatomy Review!
Cranial Nerve

Function

Cranial Nerve

Function

(VII) Facial

Muscles of facial expression;

corneal reflex; facial pain;
taste on anterior of tongue

(VIII) Vestibulocochlear

Hearing and head

acceleration and input for
oculocephalic reflex

(IX) Glossopharyngeal

Swallowing; gag reflex;

palatal, glossal, and oral
sensation

(I) Olfactory

Smell

(II) Optic

Vision

(III) Oculomotor

Eye movement, pupil

constriction

(IV) Trochlear

Eye movement

(X) Vagus

(V) Trigeminal

Mastication; facial heat,

cold, touch; noxious
odors; input for corneal
reflex

Heart Rate; GI activity; sexual

function; cough reflex; taste
on posterior of tongue

(XI) Spinal Accessory

Trapezius muscle;
sternocleidomastoid muscle

Eye movement

(XII) Hypoglossal

Tongue movement

(VI) Abducens

Cranial Nerves & Functions

Nutritional Consequences
Cranial Nerve
Smell

(II) Optic

Vision

(III) Oculomotor

Eye movement, pupil

constriction

(IV) Trochlear

Eye movement

(V) Trigeminal

Mastication; facial heat,

cold, touch; noxious
odors; input for corneal
reflex

Function

(VII) Facial

Muscles of facial expression;

corneal reflex; facial pain;
taste on anterior of
tongue

(VIII) Vestibulocochlear

Hearing and head acceleration and

input for oculocephalic reflex

(IX) Glossopharyngeal

Swallowing; gag reflex;

palatal, glossal, and oral
sensation

(X) Vagus

Heart Rate; GI activity;

sexual function; cough
reflex; taste on posterior
of tongue

(XI) Spinal Accessory

Trapezius muscle;
sternocleidomastoid muscle

(XII) Hypoglossal

Tongue movement

Function

(I) Olfactory

(VI) Abducens

Cranial Nerve

Eye movement

Video
https://www.nia.nih.gov/alzheimers/alzheimers-disease-video

Deterioration of brain function

-Amyloid beta plaques, composed of a dense proteinaceous core containing the A
peptide
-Instead of having the alpha secretase snip APP, beta secretase replaces it
-APP beta amyloid fragments are formed and become toxic to neurons
-First seen in Cortex

-Neurofibrillary tangles within neurons

-Tau protein helps stabilize structure of internal transport system
-Abnormal tau protein separates from the microtubules due to excessive
phosphorylation
-Become tangles and destroy the transport system
-First formed in Hippocampus
-Both Tangles and Plaques lead to shrinkage of brain

Part of Brain Affected

-Cerebral cortex
-Hippocampus
-Enlargement of the
ventricles

This leads to
-confusion
-personality and behavior changes
-impaired judgement
-increasing memory loss
-intellectual function
-disturbances in speech
-loss of independence
-disordered eating behavior
-weight change
-anomia
-echolalia
-agnosia

Statins for Treatment of Dementia?

In AD, -almyloid (A) protein deposited in form of extracellular plaques

Previous studies have shown A generation is cholesterol dependent

Statins generally prescribed for hypercholesterolemia

Hypothesized statins might be beneficial treatment in AD patients

Evidence/results revealed that statins had no benefit

Diagnosis

Diagnosis

Only accurate way to diagnose AD is through an autopsy post-mortem

Doctors use several methods to determine possible Alzheimers Disease:

Talk with family/friends for history of overall health, past medical problems, ability to
carry out ADLs, and changes in attitude/personality

Conduct tests:

Memory
Problem solving
Attention
Counting
Language
Neuropsychometric Testing

Doctors test for treatable/reversible causes first; once they have ruled these out, only
then do they diagnose patient with AD

Diagnosis

Doctors use several methods to determine possible Alzheimers Disease:

Rule out other causes:

Standard medical tests

Brain scans (CT, MRI, PET)

Tests performed again over time to see changes in cognitive functions

Tests may diagnose other cognitive diseases (i.e. vascular dementia or

mild cognitive impairment)

Upon diagnosis, specialists can provide a more detailed diagnosis

Geriatricians, Geriatric Physicians, Neurologists, Neuropsychologists

Obtaining a second opinion helps confirm the diagnosis

Lab Values

NOT diagnostic
Blood biomarkers may predict future risk of AD and/or dementia
A certain 10-lipid blood panel shown to be 90% accurate in predicting
future development of AD

The lipids nor their values were given

If results are replicated in further research, may be implemented as

inexpensive way to predict risk for AD
In the future- could potentially allow healthcare providers to track the progression of the

disease
Would also be beneficial for drug development

Seven Stages

Some use a simple three-phase model

Mild
Moderate
Severe

Seven stage model most common

Stage 1

NO IMPAIRMENT
AD not noticeable and cannot be detected
No memory problems
No symptoms of dementia

Professor Duncans Mom:

Didnt see much

Mom was master at hiding it
Those who are educated learn how to be good at hiding it- they are
high-functioning people.

Stage 2

VERY MILD DECLINE

AD Patient begins to notice mild memory problems (i.e. losing things around the
house)
Not differentiable from normal aging
Patient still does well on memory tests
Loved ones unlikely to notice any difference

Professor Duncans Mom:

Still not seeing much

Stage 3

MILD DECLINE
Friends & family begin to notice
Patients struggle with memory and cognitive tests
Difficulty finding right word to use in conversations
Struggle to remember new names
Struggle to plan and organize
Frequently lose personal possessions
Professor Duncans Mom:

Still fairly high-functioning, some signs showing

Stage 4
MODERATE DECLINE
Symptoms very apparent
Struggle with simple math
Forget details about their past
Poor short-term memory (i.e. forgetting what they ate for breakfast)
No longer able to manage finances

Professor Duncans Mom:

Loved to cook and sew, couldnt do either anymore

Appeared normal in public (Relief Society)
Would always give phone to husband- starting to withdraw

Stage 5

MODERATELY SEVERE DECLINE

Begin to need help with daily activities
Confusion
No longer able to recall simple details (i.e. their phone number)
Difficulty dressing themselves properly
Still able to bathe and toilet alone
Still able to recognise family/friends, & recall some detail of their life history

Stage 5
Professor Duncans Mom:

Didnt know any of her childrens names

Didnt know people, just acted like she knew people; learned to be pleasant to everyone .
Became severely dehydrated; was in the hospital, had kidney infections- almost died.
Could no longer recognize thirst; was still able to hold a cup though
No hunger cues either

One didnt need to feed her, but if food was not put in front of her, she wouldnt eat; some are the
opposite
She was combative with this; didnt want people telling her what to drink
Still able to get dressed; no idea of the seasons though
Didnt notice that she spilled on her clothes, would go out in it
Would get really mad when you pointed that out to her.
Normally very pleasant personality

Stage 6

SEVERE DECLINE
Constant supervision and care required (professional care in most cases)
Confusion/ unawareness of environment and surroundings
Personality changes & behavioral problems
Need assistance with ADLs: toileting, bathing, etc.
No longer able to recognize faces (except for closest friends/relatives)
No longer able to remember most details of personal history
Loss of bladder and bowel control
Wandering occurs

Stage 6
Professor Duncans Mom:

Completely delusional

On medications for this

On medications for delusions, sleep, and memory

Now had Parkinsons Disease as well
No sleep cycle without help; becoming more dependent on medications
Memory meds: kept the disease where it was for awhile
Could still just play the hymns, couldnt sight read new music; would come out of
delusions when kids were playing to tell them to sharp that note.
Couldnt brush teeth, personal hygiene going downhill; major shakes
Suspiciousness

Stage 7

VERY SEVERE DECLINE

Final stage of AD
AD is a terminal illness

Patients in this stage are nearing death

Lose all ability to communicate or interact with their environment

May still utter phrases, but have no idea as to their condition
Need assistance with all ADLs
Lose ability to swallow

Stage 7
Professor Duncans Mom:

Fed her for the last couple years

Didnt speak much
Unable to carry on a conversation
Dysphagia diet had to be fed.
Thickened liquids.
Was never in a facility; her dad (her moms husband) would never allow it.
Her dad is still in really good health
Very common that AD patients contract an infection they cant fight
No High BP, high cholesterol very physically healthy
Died of kidney infection, body didnt react with fever, or anything.

Seven Stages Overview

Progression
AD progresses slowly through seven, distinct stages.
Stage 1: No impairment

Symptoms not evident.

Stage 2: Very Mild Decline

Minor memory problems

Stage 3: Mild Decline

Friends and family notice

Stage 4: Moderate Decline

Very clear AD symptoms

Stage 5: Moderately Severe Decline

Need help with daily activities

Stage 6: Severe Decline

Constant supervision required

Stage 7: Very Severe Decline

No longer interact with environment

Long-Term Care Facilities

Long-term Care Facilities (LTCFs)

Includes nursing homes and assisted living facilities
Provide variety of services (i.e. medical and personal care) to those unable to live independently
Nursing homes:
For those not requiring hospitalization but cant be cared for at home
Nurses available 24 hours/day
Atmosphere depends on facility; some feel more like a hospital, others feel more like a
home
Some have special units for those with serious memory problems (such as AD patients)
Not just for elderly; open to anyone requiring 24-hr care

Long-Term Care Facilities

Assisted Living Facilities:

For those with minimal needs

Purpose: to help adults live independently
Most facilities offer:
Living arrangements
Meals
Supervision
Security
Some assistance with ADLs
Services vary depending on type of Assisted Living Facility:
Assisted Living Facility Type I & Type II

Small Health Care Facility - Type N

Cost

Nursing Homes:

As of 2010 $6235/month for semi-private room

$6965/month for private room

Assisted Living:

$3000+/month
Cost varies with type of assistance needed, residence and apt size

Long-Term Care Insurance

Best option to ensure affordability of type of care needed

Should be purchased by age 50
Will be too late once care is needed (if no insurance has been purchased)
Each insurance policy is different

RD Responsibilities in Long-Term Care

Responsibilities can include, but are not limited to

Evaluating overall menu
Developing special diet menus as well
Monitoring nutritional needs for at-risk patients
Contributing member of clinical care team
Wounds, dehydration and diabetes are common occurrences
Supervising kitchen staff
Nutritional assessments/diagnoses

RD Responsibilities in Long-Term Care

I take a quick look at the census and note 3 admissions and 2 re-admissions on my floors...Check back
with Mrs. P about her dinner last night, talk to food service director about the possibility of having egg
salad more often (because Mrs. R enjoys them), check on how Ms. Z is adjusting on the 10th floor and
then go down to 7th floor to see if Mr. C is tolerating the chopped diet. Oh, if I have time Ill go check on
the residents eating in the main dining room...What next. Oh yes, let me put in some food preferences
into the computer. Mrs. D didnt like the fish that was served yesterday for lunch, and wouldnt mind a
sandwich alternative. She also asked to have some strawberry ice cream once in awhile. Not a problem
since her cholesterol levels has improved significantly since admission. Mr. F is bored with cheerios
every morning, let me switch up the cereals so he has more variety. Ms. H would like a banana every
morning and Mr. A wants a snack at 8pm...Theres news from the Morning Report. Mrs. G is put on oral
liquid supplements for 5 lb weight loss in a week. Seriously? She eats 100% of her meals and was
swollen like a balloon last week-of course shes going to lose weight. Nurses state MD reduced diuretics.
Good. Let me check if a supplement is really needed.

Home Health/Hospice
Home Health Care:

Care provided for a patient in their home by healthcare professionals

Treatment of disease/illness/injury

Healthcare providers typically come at scheduled times

Hospice:

Palliative care

Focuses on caring for the patient, not curing the disease

In most cases care is provided in patients home
Can be provided in free-standing hospice centers
Hospice staff on-call 24/7

Typically, a family member serves as primary caregiver, and helps makes decisions for
terminally-ill individual

Medications / Treatment

Medications / Treatment
Currently there is no cure for Alzheimer disease
Current medications cant prevent the disease from progressing,
they simply help lessen the symptoms

Medications / Treatment
There are two different types of medications for treating
Alzheimer's:
Memory
Behavioral

Memory Medications
Memory medications help treat:
Memory
Thinking
Language
Judgment

Memory Medications
Two different classes of memory drugs:
1.Cholinesterase inhibitors
2.Memantine

Cholinesterase Inhibitors
Functions:
Prevents breakdown of acetylcholine

Memantine
Functions:
Regulates glutamate
Permits calcium to enter
the cell

Memory Medications

Behavioral Changes
Early stage behavioral changes

Late stage behavioral changes

Irritability

Hallucinations

Anxiety

Sleep disturbances

Depression

Delusions
Anger
Physical or verbal outbursts
Restlessness

Behavioral Changes
Factors that trigger behavior changes:
Moving to a new residence or nursing home
Changes in a familiar environment or caregiver arrangements
Misperceived threats
Admission to a hospital
Being asked to bathe or change clothes

Behavioral Changes
Non-drug approaches should always be tried first:
Monitor personal comfort
Avoid being confrontational
Redirect the person's attention.
Create a calm environment
Acknowledge requests
Look for reasons behind each behavior
Don't take the behavior personally

Behavioral Medications
Antidepressants for:
low mood and irritability
Anxiolytics for
anxiety, restlessness, verbally disruptive behavior and resistance:
Antipsychotic Medications for:
hallucinations, delusions, aggression, agitation, hostility and uncooperativeness

Recreational Therapy
Music and art can enrich the lives of people with Alzheimer's
disease. Both allow for self-expression and engagement.

Music

Studies show music therapy is effective in reducing symptoms of depression and

agitation
A patients ability to engage in music stays intact into the late stages of this disease
process because music does not require cognitive function for success.
Provides a shift in mood, manages stress-induced agitation, stimulates positive
interactions, facilitates cognitive function, and coordinates motor movements

Medical Nutrition Therapy

MNT
Medications are most effective when taken with:
vitamin E
other antioxidants
omega 3

MNT
Promotes the onset of the disease:
Diets rich in saturated fatty acids and alcohol
Diets deficient in antioxidants and vitamins

Suppresses the onset of the disease:

Diets rich in unsaturated fats, vitamins, antioxidants, wine, curcumin and some
spices

By preventing oxidative damage

MNT
Causes of Poor Appetite:

Medications
Poor fitting dentures
Not enough exercise

Difficulties:

Visual agnosia inability to

recognize food
Impaired feelings of thirst, hunger
and satiety
Loss of motor skills

MNT
As end-stage disease approaches swallowing
often becomes impossible. Dysphagia should
be managed to prevent aspiration.

Combat weight loss with:

frequent snacks
nutrient dense foods
nutrition supplements

Make Mealtime Easier

Keep meal times simple
No music or TV
Offer food choices one at a time
Use bowls in color contrast of the food
Give the person plenty of time to eat

Myths / Facts

Is AZ type 3 diabetes?
Unanswered
Not officially named type 3 diabetes; still researching
AD represents a form of diabetes because it has features that
overlap with T1DM and T2DM
Both experience Inflammatory responses, deposition of
amyloid beta and beta islet cells, obesity, ApoE4, oxidative
stress
Diabetics have a 65% higher chance of developing AZ

Is a ketogenic diet helpful in AZ?

Unanswered
- Mechanism of this diet is not fully understood;
requires further study
- Provides neuroprotection and reduces seizures
- Developing the idea of direct administration of
ketones

What is a ketogenic diet?

Ultra strict diet

Fat:carb/protein ratio = 4:1
All foods items have to be weighed to the gram
Beneficial to reduce the number of seizures
Nutritionally inadequate and insufficient calories
Meats, eggs, cheese, fish, heavy whipping
cream, butter, oils, nuts and seeds

SAMPLE MENU
Breakfast
36% heavy cream: 23 g
Fresh strawberries: 13 g
Egg substitute (scrambled with oil): 66 g
Olive oil: 24 g
Lunch
36% heavy cream: 14 g
Sliced cucumber (raw): 6 g
Sweet corn (canned, drained): 4 g
Grilled chicken breast: 25 g
Olive oil: 35 g (use for salad dressing for cucumber, cook with corn
and chicken, mix the rest with cream for beverage)
Dinner
Green beans (cooked): 14 g
Baked, lean, ground beef patties: 15 g
Butter: 35 g
KetoCal powder: 14 g
Sugar-free, low-kilocalorie gelatin dessert powder (any flavor): 1.3 g
(use to make KetoCal puddinga)
Bedtime snack
36% heavy cream: 18 g
Blueberries (fresh): 8 g
Egg white: 14 g
Olive oil: 8 g

End-of-Life Decisions

End of Life Decisions: Advance Directives

Advance Directives: documents that state your preferences for medical care
3 Types:
Living Will: describes the type of treatment you would prefer when you
become terminally ill *(feeding tubes, artificial breathing, surgery, etc).
*Terminally ill: clear you will not recover; for example, alzheimer's, or
when you only have a few weeks to live
Durable Power of Attorney for Health Care Decisions: allows a proxy you
appoint to make health-care decisions for you when you are unable to make
and/or communicate decisions for yourself.
Combination Document: combines living will with power of attorney into one

Ethics of Nutrition Support- RD Responsibilities

1.

Have sound technical judgement of a feeding strategy that will achieve the
desired goals. Share with professional team.
- recommend composition and delivery method of feedings

2.

Know what is wanted by the individual

- Educate patient and family on nutrition/hydration options/outcomes
- Serve as an advocate for client and family
- participate in legal and ethical discussions/decisions regarding
feeding

End-of-Life Care Decisions

Location of Care (home, facility, etc)

Nutrition Support

Tube-feedings vs. Hand-feedings

Artificial Nutrition
Artificial Hydration

Use of Restraints
When to stop driving
Electronic Tracking
Genetic Testing
Diagnosis Disclosure to patient
Etc.

Prof. Duncans Familys Decisions: Location

Type of Care:
At Home

At Home with
Hospice

Facility

PROS

CONS

With family
Control of care
Comfort of familiar surroundings
(?)

Same as above +
Routine check-ups
Help with pain control
Helps the family understand and
anticipate symptoms

Well-established care plans

Constant nursing staff on hand
Freedom of caregivers

Consuming to caregiver
(grandkids lose time with both
grandparents)
Difficult to manage pain
Same as above +
Still most of the care
responsibility on family
They die at home - possible
trauma for family
Infrequent family interaction
Heightened agitation
Use of harmful restraints
Higher complication rates

Alzheimers Association Position: Location

Palliative (comfort-oriented approach) in the persons place of residence

(home or care facility)

Forgo hospitalization and invasive treatments

CPR
Dialysis
Artificial nutrition/hydration

Ethics of Nutrition Support

Position on Tube Feedings for those with Advanced Dementia
Evidence DOES NOT support EN
feedings to....

Prolong survival
Improve function
Prevent aspiration pneumonia
Reduce risk of pressure ulcers
Reduce risk of infection
Provide palliation

DOES encourage:

Removing Dietary restrictions

Let the individuals preferences
guide eating habits
Hand feeding whenever possible
(one of the few pleasures left for
them)
Consideration of eating problems
as end-of-life predictors
See next slide for more...

Ethics of Nutrition Support (cont)

Some suggest minimizing hydration and nutrition for those with loss of
appetite. WHY?
Minimized hydration can lead to
Reduced disturbing oral and
bronchial secretions
Reduced cough from diminished
pulmonary congestion

Withholding nutrition:
Physiologic adaptation allows them
not to suffer from absence of food

Ethics of Nutrition Support

Health Care Professionals have an ethical obligation to protect life and to relieve suffering.
Respect of autonomy, nonmaleficence, beneficence, and justice are accepted moral principles
governing the behavior of healthcare professionals

Three Views:

Utilitarian View - positive balance of

value for all persons affected
Formalist View - some acts are right or
wrong independent of consequences
Virtues View - goals and rules are
respected, focuses on the character of
the person

Ethics of Nutrition Support (cont)

No right is held more sacred than the right of every individual to the
possession and control of his person
Health Care Providers must uphold the patients wishes (whether they agree
or not), or send them to another facility
EXCEPTIONS:
State or institution may limit that right based on :

Prevention of suicide
Protection of innocent third parties (especially children)
Protection of the ethical integrity of the health care professional

President Hinckley Quote:

Regarding questions of euthanasia and doctorassisted suicide, President Hinckley said the
answers go back to the Hippocratic Oath.
"Further, if we believe that we are part of a divine
plan, if life is sacred and death is determined by an
all-wise Creator, these are very sensitive issues with
which you deal."
He then quoted two statements from the General
Handbook of Instructions for priesthood leaders.
The first states: "A person who participates in
euthanasia - deliberately putting to death a person
suffering from incurable conditions or diseases violates the commandments of God."

President Hinckley Quote:

The second relates to the prolonging of life and reads: "When severe illness
strikes, Church members should exercise faith in the Lord and seek
competent medical assistance. However, when dying becomes inevitable,

it should be looked upon as a blessing and a purposeful part of

eternal existence. Members should not feel obligated to extend mortal life
by means that are unreasonable. These judgments are best made by family
members after receiving wise and competent medical advice and seeking
divine guidance through fasting and prayer."

President Hinckley Quote:

President Hinckley then added: "Most of you are faced with the question of
using heroic measures, so-called, to prolong life, particularly with the elderly
and infirm. I believe that most of you know what to do, and that you act
prayerfully and wisely in these difficult circumstances.
"I can only hope, I can only pray that you will counsel with your Father in
heaven as you are faced with these agonizing decisions. You are entitled

inspiration, and I believe you will receive it."

to

Case Study - RM
RM (Ralph McCormick); Age 89; Wgt 511; Hgt 138 lbs
Allergies: Penicillin

Moved to an assisted living facility 4 years ago for one year - became
combative and wandered away from the facility often
Transferred to a local nursing home for 3 weeks
Transferred to the Veterans Home (3 years -current)

Admitted for treatment of a non-healing wound 2cm x2cm x8cm on thigh (hit
his hip on the corner of his bed in a combative episode with his roommate)

Case Study: Assessment

Anthropometrics:

Normal weight (4yrs ago) = 170 - lost 30 pounds mostly in first year =
severe weight loss
Current BMI = 19 (normal)
IBW = 172 lbs. 77% IBW (underweight)

Clinical:

Pupils are small, react to light sluggishly

Disoriented to time, place, and person
Extremities are cool to touch, pale with bruising
Skin is transparent, pale, cool, decreased turgor
Open, draining, purulent wound 2cm x 2cm x 8 cm on thigh

Biochemical Assessment - What is causing these abnormal lab values?

Lab

Reference Range

RM values

8-18

22 (high)

0.6-1.2

1.3 (high)

Protein

6-8

5.5 (low)

Albumin

3.5-5

2.9 (low)

Prealbumin

16-35

14 (low)

4.8-11.8

16 (high)

Hemoglobin

14-17

13.5 (low)

Hematocrit

40-54

39 (low)

BUN
Creatinine

WBC (x10^3/mm^3)

Case Study: Assessment Continued

Dietary:

Diet modifications at Vet Home: finger foods, access to snacks 3x daily

(min)
RM had loss of appetite, difficulty focusing on eating
Required assistance at all meals
Best intake at breakfast (cornflakes, banana, high cal/high prot shake)
No history of nutrition therapy

Medications:

Furosemide, Atenolol, Lisinopril, Zocor, Haloperidol, Warfarin, Donepezil

(memory medication)

PES Statement: RM
Inadequate calorie intake related to loss of appetite as evidenced by 77% of
IBW, poor wound healing, and low prealbumin and albumin lab values.

Case Study: Nutrition Recommendations

(based on wound healing)
Calorie Needs:
30-40 kcals/kg = 1890-2520 kcals/day
Protein Needs:
1.2g/kg = 76 g/day
Fluid Needs:
30-35 ml/kg = 1890- 2205 ml/day

One-day Diet:
Total Calories: 2204 kcals
Total Protein: 77g
Diet Modifications:
Finger foods, 3 snacks a day

BREAKFAST

AFTERNOON SNACK

1 cup Cornflakes
1 med Banana
1 Vanilla Boost High
Protein

22 mini crackers
8 cheddar cheese cubes

MORNING SNACK

DINNER

1 Go-gurt - Melon-berry
cup strawberries

1 cup potstickers
1 cup edamame
cup sticky rice ball
1 Tbs soy sauce

LUNCH

EVENING SNACK

4 oz chicken tenders
1 Tbs BBQ sauce
1 cup steamed carrots
cup seedless grapes
1 cup cranberry juice

20 pieces dips icecream

Calorie/ Protein Recommendations:

-

1890-2520 kcals
76g protein