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    Mini Case Study

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    Claire Pomorski, a 72-year-old female with multiple chronic conditions including end stage renal disease, diabetes, and multiple myeloma, was admitted for unexplained syncopal episodes. Labs showed abnormalities including low potassium, chloride, hemoglobin, and hematocrit. The patient has a history of weight loss and difficulty eating. The registered dietitian diagnosed the patient with severe malnutrition and increased nutrient needs related to her conditions. The nutrition care plan includes liberalizing her diet to regular textures, adding oral nutrition supplements twice daily and pudding three times daily, recommending a renal multivitamin, assisting with feeding, and coordinating a speech therapy evaluation for chewing and swallowing difficulties. Monitoring will include weekly weight,

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    Mini Case Study

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    Claire Pomorski, a 72-year-old female with multiple chronic conditions including end stage renal disease, diabetes, and multiple myeloma, was admitted for unexplained syncopal episodes. Labs showed abnormalities including low potassium, chloride, hemoglobin, and hematocrit. The patient has a history of weight loss and difficulty eating. The registered dietitian diagnosed the patient with severe malnutrition and increased nutrient needs related to her conditions. The nutrition care plan includes liberalizing her diet to regular textures, adding oral nutrition supplements twice daily and pudding three times daily, recommending a renal multivitamin, assisting with feeding, and coordinating a speech therapy evaluation for chewing and swallowing difficulties. Monitoring will include weekly weight,

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    Claire Pomorski, a 72-year-old female with multiple chronic conditions including end stage renal disease, diabetes, and multiple myeloma, was admitted for unexplained syncopal episodes. Labs showed abnormalities including low potassium, chloride, hemoglobin, and hematocrit. The patient has a history of weight loss and difficulty eating. The registered dietitian diagnosed the patient with severe malnutrition and increased nutrient needs related to her conditions. The nutrition care plan includes liberalizing her diet to regular textures, adding oral nutrition supplements twice daily and pudding three times daily, recommending a renal multivitamin, assisting with feeding, and coordinating a speech therapy evaluation for chewing and swallowing difficulties. Monitoring will include weekly weight,

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    © All Rights Reserved
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    100 views3 pages

    Mini Case Study

    Uploaded by

    api-380538354
    Claire Pomorski, a 72-year-old female with multiple chronic conditions including end stage renal disease, diabetes, and multiple myeloma, was admitted for unexplained syncopal episodes. Labs showed abnormalities including low potassium, chloride, hemoglobin, and hematocrit. The patient has a history of weight loss and difficulty eating. The registered dietitian diagnosed the patient with severe malnutrition and increased nutrient needs related to her conditions. The nutrition care plan includes liberalizing her diet to regular textures, adding oral nutrition supplements twice daily and pudding three times daily, recommending a renal multivitamin, assisting with feeding, and coordinating a speech therapy evaluation for chewing and swallowing difficulties. Monitoring will include weekly weight,

    Copyright:

    © All Rights Reserved
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    of 3

    Claire Pomorski

    University of Maryland
    College Park
    Dietetic Internship
    2019-2020 MINI CASE STUDY

    Nutrition Assessment: Medical Diagnosis – Admitted for several unexplained syncopal episodes
    Age: ​72 Labs​:
    Gender: ​Female ​ 02/11​ ​02/12​ ​02/17
    Weight​: 54kg (119lb) K+ ​ ​3.6​ 3.5 (​ L) ​ 3.2​(L)
    Ideal Body Weight: 125lb CL ​95​(L)​ ​97 96
    Height​: 5’5” (165.1cm) BUN ​42​(H)​ 46​(H)​ 12
    BMI​: 19.8 (normal) GLU ​ 161​(H)​ 107​(H) ​ 115​(H)
    % IBW change: 95.2% Phos ​4.7​(H)​ 2.2​(L)
    % UBW change: 91.5% WBC 5.77 ​4.39​(L)​ ​ 6.22
    UBW: ​130lbs HCT ​27.9​(L)​ 25.1​(L)​ 28.5​(L)
    HGB ​9.0​(L)​ 8.2​(L)​ 9.3​(L)

    PMH
    AICD (automatic cardioverter/defibrilator), Medications​:
    Amyloid heart disease, DM2, ESRD on Acyclovir (antiviral)
    dialysis, HTN, hypothyroidism, multiple B-Complex Vitamin
    myeloma (outpatient chemo), sarcoidosis Vitamin D3
    of lung Florinef (adrenocortical steroid--adrenal insufficiency,
    BP on Admit: 138 postural HTN)
    HR on Admit: 152/84 Lopressor (beta blocker)
    Proamatine (BP support)
    Torsemide (loop diuretic)
    Symptoms Tramadol (narcotic)
    weakness, light-headed, fainted several Venetoclax (treat lymphocytic leukemia)
    times after d/c from SH 3 days prior

    Current Diet
    Diet History
    Soft and chopped foods, boost BID Renal hemodialysis (no protein restriction, 80 mEq K, 2000
    mg Na), No fluid restriction -- ED diet order
    Social History: ​lives independently with a
    husband who provides care as well as
    caregiver for 4-hrs/day x 5 days/week.

    Nutrition Diagnosis – utilize PES Statements

    Severe malnutrition in the context of an acute disease or injury related to multiple myeloma, ESRD as
    evidenced by dry weight wt loss of 8.2# (7% body weight) x 1 week; moderate muscle wasting (temporal,
    interosseous, clavicle, shoulder); severe fat loss (triceps). Malnutrition present on admission

    1
    Claire Pomorski
    Increased nutrient needs (protein-calorie) related to ESRD and CA as evidenced by pt reported difficulty
    chewing foods and relying on nutrition supplements and soft, east to eat foods

    Nutrition Intervention – Nutrition prescription, Interventions with goals


    Nutrition Prescription Intervention with goals
    Calorie needs: 1700-2000kcal NP-1.1 ​Recommend liberalizing diet to regular, with texture
    (30-35kcal/kg d/t HD and advanced age) modification (minced and bite sized) secondary to poor po
    Protein: 70-87g (1.2-1.5g/kg) intake
    Fluid Needs: Oliguria - 1000mL + urine Goal: immediately after consultation <24hrs after admit
    output ND-3.1​ Medical food supplement: add ONS Nepro BID and
    Boost Pudding TID
    Goal: within 24hrs of admit
    ND-3.2 ​Vitamin and mineral supplement: Recommend renal
    MVI (nephrocaps)
    Goal: within 24 hrs of admit
    ND-4:​ feeding assistance: meal set up, removal of lids on
    containers as pt reports not being able to open lids
    Goal: nursing or catering to assist pt at each meal
    RC-1.4: ​Coordination of care: Recommend SLP for
    consultation for chewing/swallowing difficulties
    Goal: within 12-24 hours of admit

    Nutrition Monitoring and Evaluation


    Indicator Criteria

    1. AD-1.1.2: Weight 1. pt to not lose >2% body weight per week during
    2. FH-1.1.1.1: PO intake/tolerance admission
    3. FH 1.5.2.2 High biological protein intake 2. Pt to consume 50% of meals and at least 2 ONS daily
    by next RD f/u
    3. Pt is consuming HBV protein at each meal

    Source Kcal requirements Protein requirements Fluid requirements


    Facility standards 30-35kcal/kg 1.2-1.5g/kg 1000mL + urine output
    1700-2000kcal 70-87g
    EAL Based on Mifflin St n/a n/a
    Jeor (with AF of 1.2)
    1,261kcals
    Other Source
    Online nutrition care Stage 5 ESRD on HD: >1.2g/kg with 50% 100mL + urine output
    manual 30-35kcal/kg ABV Protein
    1700-2000kcal 70g

    2
    Claire Pomorski
    References:

    NCM:
    https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=5537&lv2=255666&lv3=27
    2534&ncm_toc_id=272534&ncm_heading​=& Accessed Feb 22, 2020

    EAL:

    https://www.andeal.org/​ Accessed: Feb 22, 2020

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