Krause\'s Food & the Nutrition Care Process 14th edition CLINICAL CASE STUDY Win
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Question
Krause's Food & the Nutrition Care Process 14th edition CLINICAL CASE STUDY
Winifred, a 38 year old F, is seen at City Hospital emergency department
(ED). She has a history of hypertension, obesity and unsuccessful
weight loss attempts. She loves fried foods, soft drinks, beer and pretzels. She has a history of binge eating. Winifred is required to have a
yearly physical by her employer, but has put off scheduling the appointment until she can lose some weight. She fell down some stairs in a
work-related accident and was sent to the ED for observation. The emergency department doctor determined that Winifred has no broken
bones, but is concerned about her elevated blood pressure, 185/98. The
doctor orders laboratory tests and Winifred is admitted to the hospital.
Her medical prole today is:
Age 38 years old Normal
Height 5,1-
Weight 285 lb
Glucose 142 mg/dL; 7.8 mmol/L
Calcium 9.1 mg/dL; 2.27 mmol/L
Sodium 140 mEq/L; 140 mmol/L
Potassium 3.6 mEq/L; 3.6mmol/L
CO2 25 mEq/L/ 25 mmol/L
Chloride 96 mEq/L; 96 mmol/L
BUN 30 mg/dL; 10.7 mmol/L
Creatinine 0.9 mg/dL; 79.6 %mol/L
Albumin 3.8 g/dL; 38 g/L
Total protein 8.0 g/dL; 80 g/L
ALP 35 U/L; 0.5 %kat/L
ALT 28 units/L; 28 units/L
AST 23 units/L; 0.38 %kat/L
Bilirubin, total 1.5 mg/dL; 25.65 %mol/L
RBC 5.1 ' 10
6
mL; 5.1 ' 10
12
L
Hgb 11 g/dL; 7 mmol/L
Hct 30%; 0.30
MCV 78 mm3
; 78 fL
MCH 23 pg
MCHC 40 g/dL; 40%
WBC 8 ' 10 9
Total cholesterol 245 mg/dL
LDL 145 mg/dL
HDL 30 mg/dL
Triglycerides 210 mg/dL
Winifred is referred for medical nutrition therapy. NFPA indicates a
robust female, with excessive fat stores, normal muscular development
and no uid accumulation. Assess her nutrition status using the data
provided.
Nutrition Diagnostic Statement
Altered laboratory values related to disordered eating pattern as evidenced
by signs of nutritional anemia and dyslipidemia.
Chapter 7 Case Study p. 120
1. What is Winifred’s BMI and classification
2. Estimate Winifred’s energy and protein needs based on her anthropometric data
3. Considering Winifred’s medical history, what does her laboratory report for hemoglobin, hematocrit and mean corpuscular hemoglobin concentration suggest?
4. What do her lab values for Total Cholesterol, LDL and HDL suggest?
5. What does her triglyceride value suggest about her diet?
6. What does the lab value for glucose (non-fasting) suggest?
7. What additional lab test would be helpful to confirm answer to #6?
8. You measure Winifred’s waist circumference as 38 inches, what additional information does this provide?
9. What is Winifred’s WHtR?
10. You suspect Winifred has inflammation, what will happen to her positive and negative acute phase reactants if inflammation is present?
Explanation / Answer
1. What is Winifred’s BMI and classification?
Winifred’s BMI is 53.8. She is definitely obese for her age.
2. Estimate Winifred’s energy and protein needs based on her anthropometric data
The average energy need would be 2295 calories and protein intake level should be 85.5-103.6 grams/day.
3. Considering Winifred’s medical history, what does her laboratory report for hemoglobin, hematocrit and mean corpuscular hemoglobin concentration suggest?
For women, the ideal value hemoglobin should be around 12-15.5 grams per deciliter, the ideal hematocrit value is 36-48% and the ideal MHC should be 33-36 g/dL. All the data's suggests that she could be anemic.
4. What do her lab values for Total Cholesterol, LDL and HDL suggest?
Total cholesterol 245 mg/dL - high
LDL 145 mg/dL - borderline/high
HDL 30 mg/dL - high.
The lab values suggest that she is at the risk of developing high blood pressure, obesity, or diabetes.
5. What does her triglyceride value suggest about her diet?
The triglyceride value is 210 mg/dL. This suggests that she must have been taking fried foods, Oily and fatty foods and more sugar.
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