CASE STUD Steven is a 44 year-old male who is 5 ft 11 in tall and weighs 182 pou

Question

CASE STUD Steven is a 44 year-old male who is 5 ft 11 in tall and weighs 182 pounds. Over the last month, he has lost approximately 10 pounds, which he blames on loss of appetite and fatigue. When he went to his family doctor with flu-like symptoms, a blood test revealed a very high white blood cell count, low platelet count, and low hemoglobin. The doctor told him to proceed to the hospital for admission to rule out acute leukemia. Further laboratory tests are pending. Admitting orders include a regular diet. Steven does not have a signi- cant medical history. He is married, has three children, and enjoys a successful career. ifi Calculate and evaluate Steven's weight according to the following standards: . BMI Percent weight change Based on Steven's weight and weight change, is he at nutritional risk? Does Steven's possible diagnosis place him at nutritional risk? What other criteria would help determine his level of risk? Calculate his estimated calorie requirements. Calculate his Recommended Dietary Allowance (RDA) for protein. . Ifhe is treated for leukemia, his protein need may increase to approximately 1.2 g protin/ How much would he then require? The hospital's diet manual says that, on average, a regular diet provides 2400 calones and 90 g ofprotein. Is this diet adequate to meet his needs? kg

Explanation / Answer

(1) BMI - WEIGHT IN KG / HEIGHT IN M2

Weight of steven =182 ,1 pound =0.4535, then 182 = 182 *0.4535 =82.5kg

Height of steven =5 ft 11 inches 1 ft =0.3048m and 1 inches =0.0254.

5 ft = 5*0.3048 =1.524m ,11 inches = 11*0.0254=0.2795m.

So height = 1.524+0.2795= 1.803 =1.80m

BMI =82.5 / 1.8*1.8 = 25.46kg/m2 (Overweight)

(2) Percentage weight change=loss in weight /initial weight *100

Loss in lbs =10 ,initial weight =182 lbs

10/182 *100 = 5.49%

(3) Yes, based on the initial weight steven was overweight ,there was a need of nutritional support for lossing weight as he was having an increased risk for developing many metabolic/ chronic diseases.Based on the present weight he is under the normal range of BMI,hence he needs a nutritional support to maintain this normal range. The sign and symptoms are those of leukemia(in which there will be variation in the fliud and electrolyte,weight chnages ,changes in blood components ,etc) which requires a proper diet counselling and treatment to fight with the disease.  

(4) Yes ,stevens possible diagnosis place him in nutrional risk because a adult is said to be in nutritional risk when he /she has a deficiency or excess of diet , any eating disorder like bulimia nervosa ,any chronic disease like cancer,cardiovascular disease,diabetes etc.

(5) The type of leukemia, investigation findings like (Ph positive,FISH positive ,abnormal cytogenetics and morphology) the age of the patient ,the response to the treatment will help to determine the level of risk.

(6) a- To calculate the calories = For male (10* weight in kg)+(6.25*height in cm)-(5*age in yrs)+5

=(10*82.5kg)+(6.25*180cm)-(5*44)+5 =1735calories per day.

Acc to RDA protein required is 0.8* weight in kg =82.5 *0.8=66gm

(7) adding 1.2gm to required protien(66gm) =67.2gm

(8) yes ,it is adequate.

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