Krause\'s Food & the Nutrition Care Process 14th edition Chapter 20 Case Study M
ID: 82420 • Letter: K
Question
Krause's Food & the Nutrition Care Process 14th edition Chapter 20 Case Study
MF is an 86-year-old Caucasian female resident in a skilled nursing facility with unintentional weight loss. She was admitted 3 months ago from the hospital after a hip fracture. She had been residing in an independent living facility for several years. She reports she has been eating poorly because of difficulty moving around, being generally uncomfortable, and states, “If I am not active I don’t need to eat so much.” Intake is less than 50% of regular diet. No problems chewing or swallowing are noted after a speech language pathologist’s evaluation. Admission weight was 112 pounds; current weight is 95 pounds. Self-reported height is 5’3”; Hgb/ Hct, normal; total cholesterol, 135; and Mini Nutrition Assessment score, 5. Hip scans show slow fracture healing and no improvement in bone density; currently she is being supplemented with calcium 1000 mg/day and vitamin D 600 IU/day. Blood pressure, 128/80 with furosemide (Lasix); other medications are lorazepam (Ativan), fentanyl transdermal patch (Duragesic), senna (Senokot-S), docusate (Colace), and mirtazap- ine (Remeron).
Nutrition Diagnostic Statement:
Unintentional weight loss related to food intake of less than 50% of meals with limited physical activity as evidenced by weight loss of 17 lb.
1. What is MF’s % weight change since admission to SNF?
2. According to the Resident Assessment Instrument (RAI), is MF considered high risk?
3. What would be a more accurate way to measure MF’s height?
4. What does a MNA score of 5 mean? (Chapter 4, p. 57)
5. Estimate MF’s protein requirements using her current weight
6. What form would MF”S SNF complete (as required by CMS) to conduct periodic assessments to determine resident’s needs?
7. How do the Dining Practice Standards (DPS) affect MF?
8. MF is constipated, what do you suggest?
9. What specific nutrient needs are increased for MF?
10. What suggestions to you have for MF to promote fracture healing and increase bone density?
Explanation / Answer
Ans.1) MF’s weight change since admission to skilled nursing facility SNF is 19.4 % it is reduces from 112 pounds to 95 pounds.
Ans.2) a) Hgb hemoglobin/ Hct Red Blood Cells,are normal as well total cholestrol is comprises of Low density cholestrol which is bad cholestrol+High Density lipoprotein cholestrol+triglycerides is also normal.
b) Because of fracture in Hip MF’s movement got slowed because of that she is eating less food as movement is slow energy consumption is also low. subsequently MF weight of MF reduces from 112 to 95.so if we oversee all the above parameters are normal except HIP fracture, so it is considered that MF is not at high risk.
Ans. 3) Self reported hieght by MF is 5.3 ft & for accurate way to measure MF’s height as she fractured patient
a) For accurate measurement of height. However, a number of common disabilities and disease processes make it difficult to accurately measure standing height in many patients. Therefore, various formulae based on bones that do not change length have been developed. These methods include knee height, forearm length and demi-span.
1) Knee height
Knee height is correlated with stature and, until recently, was the preferred method for estimating height in bedridden patients. Knee height is measured using a sliding broad-blade caliper. A device designed for this purpose is commercially available. The patient's height is then estimated using a standard formula.
2) Forearm Length
This method is popular in the UK. The only tool needed is a tape to measure the ulna length between the point of the elbow and the midpoint of the prominent bone of the wrist. This value is then compared with a standardized height conversion chart.
3) Demi-Span
Clinically, the most useful measurement is the demi-span. This method is recommended by the Mini Nutritional Assessment, and, like forearm length, requires no specialized equipment. Demi-span is measured as the distance from the middle of the sternal notch to the tip of the middle finger in the coronal plane. Height is then calculated from a standard formula.
Ans.4)
Ans.5)
1) Protein requirements are based on several factors including:
2) Estimated requirements:
US & Canadian Dietary Reference Intake guidelines:
women aged 19 to 70 years old: 46 gms of protein per day (based on 57.5 kg individual).
The recommended daily protein dietary allowance is based on a normal sedentary person.
Ans.7) As MF is normal before suffering from fractured she used to eat normally as movent is normal so as per Dining Practice standard,but when MF suffered from fractured her movement got slowed and daily consumption for food is also reduce.so Dining practice affect bit to MF beacuse reduce consumption of food intake due to lack of physical activity.
Ans 8) Offcourse not MF is not constipated in any manner, as she reduces her daily consumption of food intake only beacuase of her fractured Hip,she is not able to move rapidly and required less energy than she requires, when she is normal.there is no sign test found related constipation.
Ans.9) specific nutrient needs incresed are calcium 1000 mg/day, and vitamin D 600 IU it is for rapid healing of bone from hip fractured,calcium helps to heal fractured bone.
Ans.10) 1) Complete bed rest.
2) increse intake of food which having nutritional value.calcium vitamins
3) Massage on affected area.
4) Medicine dosage to take as prescribe by doc
5) increase the intake of milk having calcium.
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