Nutrition Care Conference Riverside Health and Rehabilitation
Center Mackenzie Cannon December 2, 2014
Slide 2
Demographics Patient: CJ Age: 84 Gender: Female Ethnicity:
Caucasian (Polish descent) Admission date: 5/1/14 Date seen:
9/16/14, 11/4/14
Slide 3
Psychosocial DNR/DNI Smoker for 40 years Resident in two bed
room Active social & religious life Good spirits
Slide 4
Anthropometrics Height: 56 Weight 5/20/14: 120 lbs Weight
9/20/14: 114 lbs BMI: 18.4 IBW: 117-143 lbs%IBW: 91% UBW: 130 DBW:
130 lbs .%DBW: 88% Unintentional weight loss of 16 lbs in 6 months
= 12% loss
Slide 5
Medical Diagnosis Pernicious Anemia: A megaloblastic anemia
caused by a deficiency in vitamin B 12, most commonly from a lack
of intrinsic factor (IF), which is a glycoprotein in the gastric
juice that is necessary for the absorption of dietary B 12. If left
untreated will lead to permanent neurological damage, due to the
role of B 12 in nerve function. Relevant Signs & Symptoms:
Fatigue, Muscle weakness, & Pale skin MNT for Pernicious
Anemia: Vitamin B12: Injections, nasal spray, or high oral
dose
Slide 6
Medical History Pneumonia Lambert Eaton Syndrome Chronic
Obstructive Pulmonary Disorder (COPD) Diarrhea Atrial Fibrillation
(AFib) Edema
Slide 7
Lambert Eaton Syndrome A rare autoimmune disorder, where the
immune system attacks the neuromuscular junction; typically
resulting in weakness of: Leg muscles Facial muscles Muscles
involved in swallowing & chewing *Often associated with
pernicious anemia
Slide 8
Chronic Obstructive Pulmonary Disorder A condition in which the
lungs deteriorate overtime losing surface area and therefore the
ability to efficiently exchange oxygen and carbon dioxide.
Typically acquired through chronic exposure to air pollutants, most
commonly cigarette smoke. Relevant symptoms include: Shortness of
Breath Chest Tightness Chronic Productive Cough
Slide 9
COPD & Weight loss COPD Requires 10% to 15% more calories
due to extra effort to exhale Leads to SOB & Decreased Appetite
Impaired Nutritional Status Weight loss & Loss of Respiratory
Muscle Strength
Slide 10
Pertinent Medications Cyanocobalamin: B complex vitamin,
Anti-anemic Diet: Caution with folate supplementation Nutr: B 12
fortified foods or supplementation (IF & adequate Ca needed for
proper absorption of oral B 12 ) Oral/GI: Mild transient diarrhea.
Nausea with nasal spray.
Slide 11
Pertinent Medications Warfarin (Coumadin): Anticoagulant (AFib)
Diet: Consistent intake of Vitamin K Other vitamin supplements: E,
A Increase drug effect/decrease clotting: Onions, fish oil,
quinine, cranberry, papaya, mango Decrease drug effect: Coenzyme
Q10, SJW, avocado, high protein/low carb diet Avoid natural
products that affect coagulation Ginseng, ginko, ginger, saw
palmetto, horse chestnut
Biochemical Data Pertinent LabsNormal range Patient Results
5/20/14 Patient Results 10/31/14 RBC 4.2 - 5.4 x 10 6 uL 4.13.58
HCT37 - 47 %33.5%31.6% HgB12.5 - 16 g/dL1110.8 MCHC32 - 36
g/dL32.834.1 RDW11.5 - 14.5N/A16.4
Slide 15
Other Abnormal Labs LabsNormal range Patient Results 5/20/14
Patient Results 10/31/14 FG70-99 mg/dl84120
Slide 16
Diet Order Date: 5/20/14 & 10/29/14 Heart healthy: Used for
pts with fluid retention issues. Limits foods high in cholesterol,
fat, and sodium Ground Consistency: All meats are ground. Soft
breads, fruits, and vegetables provided. No peanut butter
Nectar-thick at all times: Used for pts with delayed swallow
determined by a swallow evaluation.
Slide 17
Diet Order Diet order is appropriate considering patient
history. AFib Edema Swallowing issues Recommendations: Increase
diet by 500 kcal a day Daily Ensure supplement to promote weight
gain
Pertinent Vitamins & Minerals Vitamin B 12 Vitamin D
Vitamin K Mg & Ca Na - Pernicious Anemia - Warfarin - COPD
(bone health) - COPD (muscle contractions/bone health) - Restricted
d/t Hx of Edema
Slide 20
Sample Menu Diet Order: Ground Consistency, Nectar Thick, Heart
Healthy Breakfast: cup Oatmeal (maypo) w/ fruit 1 cup Yogurt with
fruit 8 oz. Thickened Apple juice 1 slice Cinnamon Raisin bread
tbsp Smart balance omega 3 butter Totals: Calories: 547 Carb: 81g
Fat: 17g Pro: 17g Snack: 8 oz. Ensure Plus Totals: Calories: 350
Carb: 50g Fat: 11g Pro: 13g Lunch: I cup Vegetable stew low sodium
19 ea. Oyster crackers low sodium cup Chicken salad w/ tomato diced
2 slices Whole wheat bread low cal cup fruit salad 8 oz. Thickened
water Totals: Calories: 434 Carb: 69g Fat: 9g Pro: 32g Snack: 1 cup
Smoothie (pineapple, banana, spinach, yogurt & ice) Totals:
calories: 230 Carb: 45g Fat: 2g Pro: 13g Dinner: 1 Turkey Golumpki
1 Slice Vegetable crustless quiche cup Vegetable medley 8 oz.
Thickened water Totals: Calories: 349 Carb: 19g Fat: 11g Pro: 21g
CalCarbFatPro Sample Menu 1890264g50g96g Nutritional Goal
1919264g53g96g
Slide 21
Nutrition Care Process Assessment: Underweight BMI, Weight loss
Nutritional Dx: Unintended weight loss (NC-3.2) related to
physiological condition of COPD, as evidenced by a weight loss
greater than 10% in 6 months. Intervention: 500 kcal/day increase
Prescribe supplement: Ensure Plus Goal BMI 20-22
Monitoring/Evaluation: Monitor weight & BMI Supplement
tolerance
Slide 22
References Merritt, MD, B., & Curry, MD, C. (2014, February
12). Mean Corpuscular Hemoglobin (MCH) and Mean Corpuscular
Hemoglobin Concentration (MCHC) (T. Wheeler, MD, Ed.). Retrieved
November 26, 2014, from
http://emedicine.medscape.com/article/2054497-overviewhttp://emedicine.medscape.com/article/2054497-overview
What is Atrial Fibrillation (AFib or AF)? (2014, September 3).
Retrieved November 26, 2014, from
http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/What-is-
Atrial-Fibrillation-AFib-or-
AF_UCM_423748_Article.jsphttp://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/http://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
Kuzminski AM, Del Giacco EJ, Allen RH, Stabler SP, Lindenbaum J.
Effective treatment of cobalamin deficiency with oral cobalamin.
Blood. 1998;92:11911198. St. Florian, MS, RD, I. (2009). Nutrition
and COPD - Dietary Considerations for Better Breathing. Today's
Dietitian, 11(2), 54-54. Retrieved November 26, 2014, from
http://www.todaysdietitian.com/newarchives/td_020909p54.shtmlhttp://labtestsonline.org/und
erstanding/analytes/pt/tab/test/http://labtestsonline.org/und
erstanding/analytes/pt/tab/test/ Lambert-Eaton syndrome:
MedlinePlus Medical Encyclopedia. (2012, August 28). Retrieved
November 26, 2014, from
http://www.nlm.nih.gov/medlineplus/ency/article/000710.htm
