Hospital of Central

Connecticut
Lauren Timmerman
 Patient Assessment
Initials: S.O. Age: 50 Gender: Male

Admitting Diagnosis:
Colostomy Reversal: procto sigmoid
colostomy reversal procto sigmoid . A
colostomy is performed in order to rest the
lower part of the GI tract in order to allow it
to heal from damage from a disease.
Contributing Diagnoses:
Crohns Disease
GERD
Diverticulitis
Patients Anthropometrics
Height Weight IBW % IBW UBW % UBW Weight Change

175cm 67.9kg 72.7kg 93.4% ~71kg 96% ~4.0%

(59) (150lb) (160lb) (156lb)

History of Weight Change: Patient reports involuntary weight loss within the last
few months or so (3 months) due to diverticulitis and management of Crohns
disease. Colostomy have also contributed to weight loss.

BMI : 22.1 Normal

Nutritional Requirements
Calories: Mifflin St Jeor X injury factor =1,518 x 1.2 = ~ 1,800 kcal

kcal/kg = 25-30 kcal/kg

25 kcal x 67.9kg = 1697.5 kcal
30 kcal x 67.9kg = 2,037 kcal
= 1,700kcal -2,000kcal

Protein gm/kg = 1.0-1.5 g/kg (IBD: Crohns Disease)

67.9kg x 1.0 = 67.9g
67.9 kg x 1.5= 102g

Fluid = 30 ml/kg x 67.9kg = 2,073 ml

Current Diet Order
Upon Admit: patient was NPO

Post-surgery: clear liquid to full liquid. Patient should progress to a low fiber diet.
Once symptoms subside from Crohns then possibly increase fiber intake.
Patient Laboratory Values
Name of Lab Test Normal Range Patients Value Date Interpretation

Na 136-145mmol/L 132mmol/L 3/29/17 Low: since there is a

slight decrease,
it may only be a cause
Of medication

K serum 3.5-5.1 mmol/L 4.1 mmol/L 3/29/17 Normal

Cl 98-107mmol/L 101mmol/L 3/29/17 Normal

Co2 21-32 mmol/L 27 mmol/L 3/29/17 Normal

Creatinine 0.5-1.1 0.88mg/dL 3/29/17 Normal

Name of Lab Test Normal Range Patients Date Interpretation
Value

WBC 4.5-11.0 15.6 3/29/17 High: signaling possible

Infection or inflammation
This makes sense since
The pt. just underwent
A reverse colostomy.
However, should be
Monitored for signs of
Infection.

RBC 4.2-5.9 4.16 3/29/17 Low:Not alarmingly low,

Pt. did have
a puncture at the surgical
sight which caused
excess bleeding. Which
may be the cause of this
value.

MCV 80-100 97.1 3/29/17 Normal

MCH 27-33 34.1 3/29/17 Normal

MCHC 28%-36% 35.1 3/29/17 Normal

Labs Continued
Name of Lab Test Normal Range Patients Value Date Interpretation

Neut. 40-60% 85.8% 3/29/17 High: possible infection

Or stress response.

Lymph 20-40% 6.5% 3/29/17 Low: may be due to

infection

Absolute Mono 0.2-1.0 1.17 3/29/17 High: Possible infection

Patient Medication List
Drug/Generic Name Purpose Side Effect Nutritional Concerns

Atropine Antimuscarinic Dry mouth, constipation,

(anticholeinergic) fast heart rate,

Lovenox anticoagulant Decrease renal function Derived from pork, beware

if there is a pork allergy

Ativan Antianxiety Anorexia, increase appetite,

thirst, and increase or
decrease in weight.

Zofran Antiemetic, antinauseant Abdominal pain, n/a

constipation, diarrhea

Lisinopril antihypertensive Possible hypotension Anorexia, decreased weight

Patient Medication List cont.
Drug/Generic Name Purpose Side Effect Nutritional Concerns

Nadolol Antihypertensive, Decrease in blood Decrease in sodium,

antiangina pressure, heart failure, decrease calories
bradycardia Avoid natural licorice.

Pantoprazole antiGERD, Antisecretory Headache, dizziness, Take 30-60 minutes

diarrhea, abdominal before a meal
pain. May open cap and take
with
applesauce or juice.
May decrease absorption
of Fe, B12
Client Social History
Pertinent Social Hx:

Divorced ands successfully shops and cooks for himself.

Cooks most meals at home and does not eat out very frequently.
Eats about 2 meals a day at home, skipping breakfast. Patient
does not have further restrictions that affect his eating habits.
Physical Findings
Patient was lying down upon when interviewed.
He appeared to have an overall thin frame and chest did not appear to have
much muscle.
Legs were thin without much muscle.
Upon interaction, patient was fully alert, exuberant, and eager to learn more
about different foods and diet modifications for when he is discharged.
Patient expressed a positive increasing appetite and wishes to gain weight.
Despite having GERD, patient reports fully swallow function and no pain when
swallowing.
Nutrition History
Patient seems aware of the restrictions of the
GERD diet and the initial low fiber diet that
complies with diverticulitis and Crohns
Disease. However, patient requested further
information on the dietary restrictions and
was happy to have additional resources for his
illness.
He has reported no additional herbal or
vitamin supplement intake, and does not
partake in any recreational physical
activity.
PES

Inadequate oral intake related to new colostomy/ reverse colostomy, as

evidence by unintentional weight loss.
Intervention
Delivery: handouts and education pertaining to low fiber meals and foods that he
can consume when he progresses off of a full clear liquid diet.

Education:

Nutrition Care Manual as a resource guide for food and sample meals.
Recommended to maintain a low fiber diet, and a diet low in acidity and fatty foods for managing
GERD when he is discharged from the hospital.
Progress to a higher* fiber diet as his gut begins to heal.
Patient has also requested education on how to safely gain weight. Although he
is not clinically underweight and has a normal BMI, he will be given a small
handout and education on healthy, calorically dense foods that can help him
safely gain weight for him to reach his usual body weight.
Intervention Cont.
Coordination:

Patient will want to contact an RD for management of GERD, diverticulitis, and

Crohns Disease after he is discharged from the hospital.
The surgeon should also be in contact with the RD so that they are both aware
of the diseased part of the GI and what vitamins/ nutrients may be
compromised and if the patient still experiences weight loss.

*Patient should keep in contact with the RD specifically for managing Crohns since
it is a chronic disease. Patient should also be aware of how to manage diverticulitis
to avoid future flare ups.
Monitoring & Evaluation
Food/Nutrition Related Outcome
Patient should monitor food intake for at least the first week in order to track fiber
and calorie intake. The patient should aim for multiple small meals throughout the
day every 2-3 hours.

Nutrition Education Outcomes

Patient should be able to state 3 meals he can have that are low fiber.
Patient should be able to state 3 foods he should avoid to avoid GERD.
Patient should be able to state the food intake pattern he should adhere to ( small frequent meals/
snacks every 2-3 hours). This will help manage GERD, diverticulitis, Crohns, and allow for easier
weight gain.

Nutrition-Focused Physical Findings Outcomes

Patient should aim to gain weight. Aim for an increase in appetite

Meal Plan & Current Diet

For the current diet order of full liquids, patient is not allowed any solid food
items. However, they are allowed substances that range in consistency from
water to jello.

The patient will progress to a low fiber diet which will include most foods
except low amounts of whole grains, nuts, seeds, and leafy vegetables. This is in
order to rest the GI system form the diverticulitis and the colostomy surgery.
 Meal Plan Example
Breakfast Lunch Dinner
Rice Sweet Potato
Bagel
Tilapia Baked Chicken
Orange Juice
Roasted Carrots Green Beans
Cream cheese
Pineapple Low Fat Milk
Snack Snack Snack
Tomato Juice Graham Crackers Low Fat Yogurt
Egg Substitute Honey Granola
White Toast Banana
Blueberries
Totals:
CHO: 216g Fat: 52g Protein: 116g
Fiber: 10g
Thank You!
Questions?
References
]
Academy of Nutrition and Dietetics. (2017). Nutrition Care Manual. Retrieved from Academy of Nutrition and Dietetics Website:
https://www.nutritioncaremanual.org

CalorieKing Diet and Weight Loss. Calorie Counter and More. CalorierKing-Diet and Weight Loss. Calorie Counter and More. N.p., n.d.
Web. Mar. 2017. http://www.calorieking.com/.

L. Kathleen Mahan, S. E.-S. (2017). Krauses Food & the Nutrition Care Process (14thed. ) St. Louis, Missouri: Elsevier Inc.

Zaneta Pronksy, S.J. (2015). Food Medication Interactions (18th ed.). Birchrunville: Food Medication Interactions.