ࡱ> _ *bjbj,E,E .N/N/DDDXXXX,XOg@@@@@TTTfffffff$jmfDTSTTTf@@: gWWWTZ@D@fWTfWWch^Rd@iU~cfg0OgcMnVMn RdMnDRdhTTWTTTTTffVTTTOgTTTTMnTTTTTTTTT : MNT I Nutrition Care Process Project Students Name: Elona Sevo Patient/Clients Initials: Mr. J ASSESSMENT: Summary of subjective and objective data from chart review and patient/caregiver. Pts age:53 Male/Female Dx: H. Pylori Infection Medical Problems/PMH: Duodenal ulcer, acid reflux after meal  Ht. Current Wt UBW/%UBW IBW range /%IBW WC* BMI 58203188lb/108%154lb./131%98 cm.30.9Interpretation of wt. status: Based on patients BMI and %IBW they are in the obese category. There is no concern for waist circumference as it is under 40. Patient has an 8% increase in body weight in the past three months.  *WC Waist Circumference  Estimated energy needs (note equation used): (Harris-Benedict) 66.5+13.8(92.2kg) + 5.0(172.72cm) 6.8(53 yrs.) 1843 cal. * 1.2 = 2212 Estimated protein needs (note g/kg): Protein 20% At 1.00 g/kg (92g of protein)Estimated CHO/Fat needs: Fat 30% (61.4g) CHO 50% (230g) Fluid needs (note equation used): 25-55 yrs. Old (35 mL/kg) 35(92.2) = 3227    D. Dietary Adjustments: 5 points Overall what type of changes in Mr. Js diet would you recommend? Some recommendations for Mr. J would be a lower calorie consumption, lower carbohydrate intake to around 230 grams, lower fat consumption to about 60 grams, increase fluids to 3.2 Liters, increase vegetable intake, increase vitamin and mineral intakes such as potassium and vitamin D, avoid alcohol use. Make adjustments to his diet to help him lose weight and manage his GI symptoms. Diet History (24 recall): Adjustments to diet: Breakfast: 1 medium banana, 2 large coffees with 2 packets of sugarAdd protein such as an egg and cut coffee to 1 with 1 packet of sugar.Lunch: 1/4 lb. cheeseburger (no bun), 1 medium (1/2 cup) French fries with 4 pkts ketchup, 12 oz. regular cola Replace cola with a vitamin D fortified orange juice or water, and instead of fries add sides of salad and whole grain bread.Afternoon Snack 2 oz. cheddar cheese 6 saltine type crackers 8 oz. sweet iced teaSwitch crackers to whole grain crackers or fruit to accompany the cheese. Switch iced tea to a cup of fortified milk. Dinner 1 cup instant white rice with 2 tsp butter 1 cup corn or peas 4 oz. fried shrimp or chicken 1 Tablespoon hot sauce 12 oz. regular beerSwitch to brown rice or quinoa and a side of mixed steamed vegetables. Could also add a protein with the brown rice such as 3 oz. of chicken breast and cut brown rice to 2/3 cup. Use cayenne pepper instead of hot sauce to cut Na. Replace alcohol with water. Snack: 6 oz. fruit yogurt, 1 oz. walnuts 16 oz. waterSwitch to a Greek yogurt with vitamin D and protein and add fresh fruit on the side.  List medications; implications and nutrition related side effects in the chart: MedicationImplication (mechanism of action) e.g. Lasix diureticNutrition side effects and Contraindications (such as alcohol): Factors that can affect nutrition intake, GI, vitamins, minerals and labs.TetracyclineAntibioticTake 1 hr. before or 2 hrs. after food/milk. Ca, Fe, Mg, Zn or MVI minerals, antacids and fortified foods to be taken 3hrs. before or 1 hr. after drug. Nutrition- Anorexia, chelate formation with Ca, Fe, Mg, or Zn. May lower vitamin K. Possible vitamin B deficiency. Increased risk of benign intracranial HTN with vitamin A supplement. Decreased skeletal growth in children. MetronidazoleAntibiotic, Amebicide, AntitrichomonalTaken orally or IV. Take with meals to lower GI distress, but food decreases drug bioavailability. Diet- low sodium recommended Nutrition- Anorexia Oral/GI- Dry mouth, stomatitis, metallic taste, epigastric distress, diarrhea, constipation S/Cond: Avoid all alcohol during use and for three days after. Increased risk of dental problems. Blood/Serum: lowered TG, Bismuth SubsalicylateAnti-diarrhea & NauseaConstipation, high or low uric acid, decreased potassium OmeprazoleAnti-ulcer, anti-gerdCan be taken orally or IV. Drug-for optimal effect take 30-60 minutes before meal. Diet: may lower Fe, B12, and Ca absorption. Ca supplement advised. Avoid gingko. Oral/GI- decreased gastric acid secretion, increased gastric pH, nausea, abdominal pain, diarrhea S/Cond: avoid alcohol Blood/Serum: decreased B12 possibly, increased cholesterol, increased glucoseAdvilAntriarthritic, Analgesic, NSAIDTake with food or milk to avoid GI irritation. Limit caffeine. Avoid or limit garlic, gingko, ginseng, ginger, horse chestnut. Nutr: can decrease appetite Oral/GI: bloating, diarrhea, constipation S/Cond: Avoid alcohol Blood/Serum: High KGeneral assessment: Client must avoid all alcohol for the next 7-10 days and be very cautious thereafter while taking Omeprazole and Advil. Also, for the next 7 days while on Metronidazole client should remain on a low Na diet. To avoid GI distress the Metronidazole should be taken with food and caffeine limited with Advil. Monitor B12, cholesterol, glucose, and potassium.   List abnormal labs and interpret in the chart: Abnormal Laboratory Test( or (Reason for AbnormalityNutritional Implications (what should be done nutritionally to correct the lab if applicable)PotassiumLowLow potassium in diet and taking Tetracycline and Bismuth Subsalicylate that may lower KConsume more Potassium in dietHbA1cHighHigh consumption of carbohydrates and taking Omeprazole that may increase glucoseKeep CHO consumption at around 230g. HDL-CLowSedentary lifestyleIncrease exercizeTriglycerideHighMeals high In saturated fatsSwitch to healthier fatsGeneral assessment: Potassium intake should be at 4700 mg., especially when taking Tetracycline and Bismuth Subsalicylate. Carbohydrate consumption should remain consistent at around 230 g. and client should increase exercise to increase HDL-C. Also, Triglycerides at 270 put patient in high risk category and should be decreased by limiting saturated fats.   NUTRITION DIAGNOSIS: Problem Etiology (related to) Signs and Symptoms (as evidenced by) P-E-S Statement: Excessive energy intake related to food and nutrition related knowledge deficit concerning energy intake as evidenced by intake of energy in excess of estimated or measured energy needs. PES Statement: Less than optimal intake of healthy fats related to food and nutrition related knowledge deficit concerning types of fats as evidenced by triglycerides higher than 150 mg/dL.  MEASUREABLE GOALSINTERVENTIONGoal 1: Reduce weight to 191 pounds in the next three months Plans for Goal 1: Reduce calorie intake by 500 calories. Educate client on adding vegetables and healthy carbohydrates to diet. Educate client on replacing high sugar drinks with healthier, nutrient dense fluids. Goal 2: Reduce triglycerides to 150mg/dL or less at next blood test. Plans for Goal 2: Educate client on the difference between saturated and unsaturated fats. Provide client with a list of fats he can use as a replacement for saturated fats in his diet.  I. MONITORING and Evaluation: 2 points Identify what will be used to monitor and evaluate the effectiveness of the intervention: __X___Weight _____food intake at meals __X___Labs (specify) _____Other Weight will be checked for increase or decrease to see if intervention has been effective. Also, labs will be checked for A. Weight status: 3 points B. Estimate nutrient needs: 4 points C. Nutrient analysis of diet recall: 4 points Analyze diet recall using diet analysis software and summarize your report here: Report Kcal, g Protein, CHO, Fat and report any vitamins or minerals not meeting needs: Do not attach your diet recall report include summary e.g., what percent of vit/min is pt getting compared to RDA; 52% Calcium, 30% Vitamin C. Based on Mr. Js 24 hour recall Sodium: 204% Calories: 2970 Biotin: 28% CHO: 380g (50.8%) Vitamin C: 44% Protein: 95g (12.7%) Vitamin D: 2% Fat: 111g (33.5%) Vitamin E: 28% Fluid:1.3 L Vitamin K: 56% Potassium (42%) Chromium: 5% Flouride: 4% Iodine: 22% Magnesium: 54% Based on a 24-hour recall, client is consuming excessive calories, including fat and carbohydrates. He also has an intake of only 40% of recommended fluids and has a low consumption of Potassium, Biotin, C, D, E, K, Chr, Fl, I, and Mg. Na intake is at 204% of the daily recommendation. E. Meds: 5 points F. Labs: 5 points G. PES: 4 points H. 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