SUFFOLK COUNTY COMMUNITY COLLEGE RIVERHEAD, NEW YORK DTE 121 Clinical Nutrition
ID: 242797 • Letter: S
Question
SUFFOLK COUNTY COMMUNITY COLLEGE RIVERHEAD, NEW YORK DTE 121 Clinical Nutrition Case Study Mr. D is a 73 YOWM who has lived with his son for the past five years. He ambulates well but his mental powers are slipping. He has a hard time remembering from one day to the next. His son has noticed his father's condition deteriorating significantly over the last six months. Because of his condition and inability of the family to provide proper attention at home, he should have been in a nursing home, but he refused to go. His son knows it is best for his father, but he does not have the heart to admit him Mr. D has not been eating well. He has been losing weight and was becoming weak. He said he just did not feel like eating. Nothing tasted the same. He had dentures but refused to wear them. He claimed they were too loose and would fall out if he tried to eat with them. His daughter-in-law did the cooking, but she did not always have the time to fix extra soft foods especially for him. She tried feeding him pureed food, but he absolutely refused to eat "baby food." His eyesight and hearing have also been failing. He was being treated for many disorders, none of which were serious. He was taking several medications which created another problem with his failing memory, He either forgot to take his medicine, or he took too much. His medications included: Haloperidol (Haldol); Lanoxin, Milk of gnesia; famotidine (Pepcid); Etanercept (Enbrel); Flurazepam hydrochloride (Dalmane); Di-Gel and aspirin for frequent headaches. One day his son and daughter-in-law returned home from work and found him on the floor, unable to get up. He was in pain and was not able to move his left leg His son called for an ambulance and brought him to the hospital His Dx were: in, Fx left femur . Senility * Dementia 3) Arthritis . Cachexia .RIO malignancy Normally, weighing a patient with a broken leg would not be attempted, but Mr. D was so thin, a bed weight was obtained after stabilization of the Fx. Mr. D weighed 133 Ibs. and was 6 0' tall. His son was embarrassed by the Dx and his fathers weight. He said "I knew my father was losing weight. I did not realize he lost this much. Mr. D weighed 165 Ibs. a year ago. The RD visited Mr. D. but, because of his mental status, did not try to interview him formally. She did interview his son to obtain his father's likes and dislikes. Mr. D's anticipated hospital stay was not long The son was now planning to place his father in a nursing home. In her chart note, the RD indicated these observations and stated that she or her diet tech would visit the patient on a daily basis during the noon meal to evaluate meal acceptance. She also indicated that she would initiate a calorie count to determine actual daily energy and protein intake. Mr. D's Medical Nutrition Therapy (MNT) included: High protein mechanical soft (edentulous) diet with snacks (A.M., P.M., H.S.) * Encourage fluids Nutrition consultExplanation / Answer
6.
Aging: The patient is 70 years old and the aging itself will reduce the senses like taste, vision and hearing
Senility: The mental instability of old age causes sensory impairment like a taste.
Dementia: Dementia causes the loss or deterioration of senses.
Medications :
Lanoxin: According to FDA loss of taste occurs with digoxin especially for people more than 60 years old, females and in case of prolonged use, people who take Coumadin, and hypertensive.
Etanercept: Loss of taste is associated with the use of Enbrel commonly in people who are more than 60 years old, females, use of drug less than one month.
Flurazepam: bitter taste of flurazepam prevents the hunger and may impair taste
Aspirin: Poor taste is seen in female patients, elderly, long duration of use -for 1 - 6 months
7.
Weight is 133 lbs i.e 60.32 kg (133 x 0.45359237)
Height of patient = 6 feet i.e 183 cms
IBW ideal body weight or desired body weight
Formula
Estimated Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet.
For Mr. D
His height is 6 feet i.e. 5 feet + 12 inch (i.e. 1 feet)
IBW = 50 kg + (2.3 kg x 12 inch) = 50+27.6 = 77.6 kg
Percentage of IBW =Actual weight/ expected weight X 100
60.32/77.6 x100= 77.73 %
Deficit is 22.27 %
8. UBW = Usual Body Weight
As per the patients son Mr. Ds weight was 165 lbs before one year
i.e. 74.8427
He lost (74.84 – 60.32 present weight) 14.52 kg over the past year
percent weight change = percent UBW – 100
Patient lost 19.4 % weight over 1 year. ((60.32/74.84 x 100 )- 100)
Severe loss of weight
9. Recommended dietary allowance of protein for the age group is 56 grams/day
Protein intake of sedentary adults = 0.8 g of protein per kilogram of body weight.
The desired body weight is 77.6 kg
So the patient needs 77.6 x 0.8 g = 62.08 grams of protein per day
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