Question

133% Julie, a 74-year-old woman was evaluated in an outpatient clinic. She lives with her 77-year-old husband, John, who is her primary caregiver. He reports that approximately two years ago his wi began to lose interest in the things she enjoyed like reading, cooking, and shopping. Gradually she has become less interested in food and has lost 18 pounds in the past year. Her current weight is 120# and she is 5' 8". Additionally, Julie has become increasingly anxious and tends to pace around the house during the day. John has tried commercial nutritional supplements (Boost and Ensure) for Julie, but has not been successful getting her to consume them. He stated he is not much of a cook but has been trying his best. He is frustrated and concerned about his wife's weight loss and lack of appetite. He feels he constantly trying to get her to eat. He does not have any family support as he and his wife never had children. Her medical evaluation revealed cognitive impairment using the Mini-Mental State Examination. She does not appear to have any chewing or swallowing problems but has not seen a dentist in over a year, She takes one prescription medication for her arthritis is Two years later, Julie (now 76) was placed in a nursing home due to John's inability to meet her increasing health care needs in the late stages of Alzheimer's disease (stage 6). This was a very difficult decision for John. Julie had been on a very liberal diet at home, and frequently ate soft oatmeal raisin cookies throughout the day along with other soft food that John could feed she was pacing thoug h out the house. The foods included whole milk yogurt and soft sandwiches such as peanut butter and banana sandwiches. Because of this diet of the 15 pounds she had lose two years ago , Julie has gained back about 1 changed to a diabetic diet. Now Julie is refusing almost all meals and fluids in the nursing home. Her family has been asked to decide on their plan for provision of tube feeding and IV fluids should this become necessary. In the meantime, the dietary department is doing their best to offer foods to Julie that she used to like and eat well within the guidelines of a diet for diabetes. Julie is unable to feed herself with utensils and she gets agitated when placed in the dining room with the other residents. She has been losing weight over the past two months since her admission. After being admitted to the nursing home, Julie was diagnosed with diabetes and

Answer 1

11, weight 120Ib = 54kg

Height 5 .8= 1.73m or 172cm

BMI = 54 ÷[1.73X1.73]

54 ÷ 2.9

BMI = 18.6 (underweight)

She lost 18pounds..she is in high risk due her current weight loss like malnutrition, decreased immune system, low bone density, diabetes, Alzheimer's dementia due to poor nutrition intake..

12, poor dietary intake affects food consumption, nutrition status..find out the underlying cause for her poor food intake..check the past and recent diet history.. calcute the daily requirement of calories, fat, protein and fluid needs..check patient BMI..plan the diet with daily needs of nutrients with high energy and protein food..have a dietary measures every 4weeks..

Calorie requirement:

= 10 X ( weight in kg) +(6.25 X height in cm) - ( 5 X age in years)- 161

10 X 54 + (6.25X 172)- ( 5 X 74)-161

540+1075 - 370-161

1615- 370 - 161

1084kcal / day

Protein requirement = 127g

Fluid requirement = 1080ml/ day