Question

Ms. Swanson is a 92-year-old resident at Northern Oaks Nursing Center who is being admitted to the local hospital for dehydration and weight loss of 8 pounds in the past 2 weeks. Her medical history includes advanced dementia, a stroke 2 years ago that left her unable to feed herself, and high blood pressure. Her anthropometric measurements include: height 5 feet 2 inches, weight 91 pounds. Ms. Swanson's usual appetite is pretty good. She is on a ground/minced diet due to swallowing difficulties as a result of her stroke. Prior to hospital admission her appetite had declined significantly and she refused to drink most fluids offered to her during the day by nursing and dietary staff. At the hospital an IV is started to help correct her dehydration (which was confirmed via lab work). Her lab work also indicates her transthyretin is low (15 mg/dL). An inpatient dietitian is assigned to Ms. Swanson to help increase her kcalorie and protein intakes in addition to her overall food intake. (See Note below) 1. What is Ms. Swanson's desirable (or healthy) body weight? Discuss how you determined her desirable (or healthy) body weight. 2. What is her percent ideal body weight? (%IBW) (Show your calculations.) 3. What are some physical signs of dehydration that might be seen in a patient? 4. What does Ms. Swanson's low transthyretin indicate about her current state of health? 5. What suggestions do you have for increasing Ms. Swanson's kcalorie and protein intakes? 6. What suggestions do you have for increasing Ms. Swanson's overall food intake?

Answer 1

Answers are as follows:

1. According to BMI (body mass index) , weight(kg /height(metre square)

= 41.36/ 1.5748(square) *After conversions

= 41.36 /2.47999504

=16.67

Normal BMI is 18.5 to 24.9. Thus, Ms. Swanson's desirable weight is 45.9 to 62kgs.

2. percent ideal body weight:

=(Actual body weight/ Ideal body weight) X 100

-Calculate ideal body = 45.5kg + 2.3 kg for each inch above 5 feet

IBW= 45.5 + 2.3 X 2

IBW= 50kgs

Now calculate Percent ideal body weight according to formula mentioned above

= (41.36/50) X 100

=0.8272 X 100

= 82.72%

Normal % ideal body weight= 90- 110%

Thus %ideal body weight is low.

3.Physical signs of dehydration include:

- Dry skin

- Dry oral mucosa,dry lips

- Dry skin

- Poor skin turger

- weight loss

- concentrated and dark urine

- Tired appearance

4. Transthyretin, also call Pre-albumin is an important indicator to detect malnutrition

Ms. Swanson's transthyretin is 15mg/dl which is low and indicates malnutrition. Thus, she needs diet assessments and modifications too.