Mr. D is a 73 YOWM who has lived with his son for the past five years. He ambula

ID: 242813 • Letter: M

Question

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 hits medicine, or he took too much. His medications included Haloperidol (Haldol); Lanoxin, Milk of Magnesia; famotidine (Pepcid): Etanercept (Enbrel); Flurazepam hydrochloride (Dalmane), Di-Gel Liquid: 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 wer .Fx left femur Senility * Dementia Arthritis . Cachexia * Dehydration 3411 R/O 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 lbs. and was 6' 0" tall. His son was embarrassed by the Dx and his father's 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 Mr. D weighed 165 lbs. a y 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 with sacks * Nutrition consult

Explanation / Answer

12. Nutritional supplementation

Nutritional supplementation

Proteins

Calories

Milkshake with whole milk – 1 Cup

420

Serving blender eggnog made with whole milk – 1 Cup

423

Instant breakfast with whole milk – 1 Cup

17.5

290

Peanut butter – 2 tsps

230

Meat,Fish or poultry – 1 Ounce

Whole milk – 1 Cup

160

13. The Vitamins and minerals that will support Mr D to recovery are:

Calcium: This mineral will help heal the fractured bone .

Good sources: Milk, yogurt, cheese, cottage cheese, broccoli, turnip, kale, soy, beans, canned tuna or salmon with bones, almond milk, and fortified cereals or juice.

Vitamin D: helps the blood take in and use calcium and build up the minerals in Mr.D’s bones.

Vitamin D is found in only a few foods like egg yolks and fatty fish, but it’s added to other foods.

Good sources: Swordfish, salmon, cod liver oil, sardines, liver, fortified milk or yogurt, egg yolks, and fortified orange juice.

Vitamin C : helps build collagen which is a protein that aids in healing the fractured bone

Vitamin C is available in fresh fruits and veggies. Aged or heated produce can lose some of its vitamin C, so go for fresh or frozen.

Good sources: Citrus fruits like oranges, kiwi fruit, berries, tomatoes, peppers, potatoes, and green vegetables.

Iron: helps make collagen to rebuild the broken bones. It also plays a part in getting oxygen into the bones to help them heal.

Good sources: Red meat, dark-meat chicken or turkey, oily fish, eggs, pulses, dried fruits, leafy green veggies, whole-grain breads, and fortified cereals.

14. Weight Calculation

Formula: Adult 55-75 years: 30 mL/kg body weight

Mr D’s weight in Kgs is 60.3

So 30mL x 60.3 = 1809 mL fluid is required.

The Nutritional supplementation should be able to provide more than half the required fluid for Mr D.

Fluid from dietary sources: Whole milk, fruits and Vegetables (Oranges, Cantaloupe, Celery, Strawberries -92% of fluid)

Detailed Recommendations to motivate Mr.D to have his food