Question

consume? H.Case Studies T.M. is a 57 yo male admitted with SOB and dyspnea. He has a PMH of DM, HTN . hyperlipidemia and CKD2. He reports a stable weight> year and a good appetite and PO intake prior to admission. T.M. reports he lives alone, is sedentary, and consumes mostly take-out meals, such as American Chinese food and fast foods. Weight: 97kg Height: 175cm BP: 144/94 DM Fingersticks (AccuChecks): 204-321mg/dLx 24 hours HgbAlc: 9.3% What is T.M. 's BMI? What category is his BMI? Show calculations a. b. What lab values are abnormal for T.M.? What do they indicate? c. Using Mifflin-St Jeor x 1.1, what are T.M.'s estimated energy needs? Show calculations d. What are two possible nutrition diagnoses for T.M.? 2. D.C. is a 94 yo female admitted with fever and pneumonia. She has a PMH of CAD and Alzheimer's Disease, diagnosed 6 years ago. SLP conducts an evaluation and recommends a 5 DFN 348 Summer 2019 Pureed Diet with Nectar Thick Liquids for the patient and defers other therapeutic diet sa poor historian, therefore pt's daughter provides diet and modifications to the RD. D.C. weight history. Pt's daughter reports pt's usual body weight one month ago was 56kg. Reports pt has become more lethargic beginning about three weeks ago and now coughs and chokes during meals and when sipping liquids. Pt's daughter states she has started cutting up foods into smaller pieces for pt to eat and pt is often too lethargic to finish her meals, consuming <50% of her intake at baseline. Weight: 50kg Height: 165cm BP: 109/72 What is D.C.'s BMI? What category is her BMI? Show calculations. a.

consume? H.Case Studies T.M. is a 57 yo male admitted with SOB and dyspnea. He has a PMH of DM, HTN . hyperlipidemia and CKD2. He reports a stable weight> year and a good appetite and PO intake prior to admission. T.M. reports he lives alone, is sedentary, and consumes mostly take-out meals, such as American Chinese food and fast foods. Weight: 97kg Height: 175cm BP: 144/94 DM Fingersticks (AccuChecks): 204-321mg/dLx 24 hours HgbAlc: 9.3% What is T.M. 's BMI? What category is his BMI? Show calculations a. b. What lab values are abnormal for T.M.? What do they indicate? c. Using Mifflin-St Jeor x 1.1, what are T.M.'s estimated energy needs? Show calculations d. What are two possible nutrition diagnoses for T.M.? 2. D.C. is a 94 yo female admitted with fever and pneumonia. She has a PMH of CAD and Alzheimer's Disease, diagnosed 6 years ago. SLP conducts an evaluation and recommends a 5 DFN 348 Summer 2019 Pureed Diet with Nectar Thick Liquids for the patient and defers other therapeutic diet sa poor historian, therefore pt's daughter provides diet and modifications to the RD. D.C. weight history. Pt's daughter reports pt's usual body weight one month ago was 56kg. Reports pt has become more lethargic beginning about three weeks ago and now coughs and chokes during meals and when sipping liquids. Pt's daughter states she has started cutting up foods into smaller pieces for pt to eat and pt is often too lethargic to finish her meals, consuming <50% of her intake at baseline. Weight: 50kg Height: 165cm BP: 109/72 What is D.C.'s BMI? What category is her BMI? Show calculations. a.

Answer 1

1.T.M is a 57-year-old male admitted with SOB and dyspnea. He has a PMH of DM and hypertension, hyperlipidemia, and CKD2. He reports a stable weight >1 year and a good appetite and PO intake prior to admission.T.M reports he lives alone, is sedentary and consumes mostly take-out meals such as American Chinese food and fast foods.

a. What is T.Ms BMI? What category in his BMI?

BMI = 703 x Weight in Ibs/(Height in inches)²

=703 x 213.8/(4733.4)²

=703 x 0.0451

=31.75

The category of BMI comes under obese. Thus the BMI calculations show that she is obese.

b. What lab values are abnormal for T.M and What do they indicate?

In the present scenario, the patient RBS and the HbA1C levels are increased and abnormal.

The accu-check value 204-321 shows the patient is hyperglycemic and as well as the HbA1C level is 9.3% indicates that the patient is in the stage of chronic diabetes.

c. Using Mifflin StJeor x 1.1, What are T.Ms estimated energy needs?

Men: (10 x weight in kg) + (6.25 x height in cm) – (4.92 x age) + 5

=(10x97) + (6.25 x 175) - (4.92 x 57 + 5

[(970 - 1093.75) - 280.44] + 5

(2063.75 - 280.44) + 5

=1783.31+ 5

=1788.31

d. What are the possible nutrition diagnoses for T.M?

1. Imbalanced Nutrition: More Than Body Requirements
2. Disturbed Body Image

2. What is DCs BMI? What category is her BMI?

BMI = 703 x Weight in Ibs/(Height in inches)²

=703 x 110.2/(64.9)²

=703 x 110.2/4212

=703 x 0.026

18.278

Here the BMI value is less than 18.5, that means D.C is thin

B. Causes of abnormality(High Vs Low)

*Sodium: 135 and 145 milliequivalents per liter (mEq/L).

Hyponatremia: less than 135 mmol/L (135 mEq/L)

Hypernatremia:  more than 145 mmol/L

These two abnormalities may result from ay result from changes in the balance of water in the body and levels of sodium in the blood

*Potassium: 3.5-5.0 milliEquivalents per liter (mEq/L)

Hypokalemia: less than 3.5 mEq/L

Hyperkalemia: 5.1 mEq/L to 6.0 mEq/L

The main abnormality of potassium abnormality is  changes in potassium intake, altered excretion, or transcellular shifts

*Calcium: 8.5-10.2 mg/dL

Elevated calcium range: more than 10.5mg/dl

Less calcium range: less than 8.2 mg/dl

The main abnormality for the calcium is parathyroid and thyroid disorders

*BUN: 7 to 20 mg/dL

Creatinine: 0.6 to 1.2 milligrams (mg) per deciliter (dL)

The main reason for abnormality in BUN and creatinine level is because of kidney disease or blockage of the flow of urine

*GFR:  90 to 120 mL/min/1.73 m²

The main abnormality for the abnormal GFR rate is kidney disease

*Blood Glucose:

Fasting blood sugar level: less than 100 mg/dL (5.6 mmol/L)

The main reason for abnormal glucose levels are due to Unhealthy lifestyle, insulin resistance and age

HbgA1c: 4% and 5.6%

Haemoglobin A1c levels between 5.7% and 6.4% mean you have a higher chance of getting diabetes.

Levels of 6.5% or higher mean you have diabetes.

The main reason for the abnormality is due to age are insulin resistance

*Triglycerides: Less than 150 milligrams per deciliter (mg/dL), or less than 1.7 millimoles per liter (mmol/L)

Borderline high — 150 to 199 mg/dL (1.8 to 2.2 mmol/L)

High — 200 to 499 mg/dL (2.3 to 5.6 mmol)

The main reason for the abnormality is due to cardiovascular disease and unhealthy lifestyles

*ALT/AST: 10 to 40 units per liter and

ALT between 7 to 56 units per liter.

Mild elevations are generally considered to be 2-3 times higher than the normal range.

The main reason for abnormal ALT/AST is an unhealthy lifestyle

*Albumin: 3.4 to 5.4 g/dL.

The main reason for an abnormal result is due to malnutrition.