Anastasia Maczko

Admitted: Sept 10, 2014 - 12:54 EDT via ER

Patient presents with bilateral knee pain x 1 week ago, difficulty walking, left leg and right foot
numbness. BP 216/91 upon arrival, finger stick = 412 and hypokalemic.
Allergies: penicillin
Patient lives alone and uses cane.
Patient received information on pressure ulcer prevention and type two diabetes control.
Patient cannot remember medication names or doses compliance factor.
Notes:

Pt admitted to ER via stretch with son for medical treatment/observation

Patients daughter manages home medication
Patient had decreased appetite for two weeks and lost 15 lbs trying to
Patients appetite increased at hospital
Patient was very receptive to DM education and willing to make change
o Did not what a CHO was pta
Patient requires partial assistance and has had reported falls in the past year
o Legs giving out
Former smoker, stopped 15 years ago
Religion: Jehovahs witness
CT performed to check for head injury d/t recent fall

Discharge Plan
- Pt appt with Cigna Health Spring office 9/12/14
- Bring all medication speak with internist, social worker and pharmacist to adjust insulin and
blood pressure medications
- Final diagnosis: diabetic neuropathy, uncontrolled DM, uncontrolled HTN, osteparthritis of
bilateral kneeds, hypokalemia resolved

Anastasia Maczko

Nutrition Assessment: Medical Diagnosis Bilateral leg pain, RN consult for wgt loss >15 lbs
Age: 74 y/o
Labs:
Gender: Female
9/09/14
09/11/14
Weight: 63.4 kg, 140 lbs, 138% IBW
Na
139
140
UBW: 79 kg, 174 lbs
K
3.3 L
3.0 L
Height:153 cm, 50
Cl
l 98
103
BMI: 27 (overweight), UBW BMI 33
CO2
30
26
BUN
15
10
PMH
Creat
0.83
0.74
Uncontrolled HTN
Gluc
456 H
218 H
Uuncontrolled DM
Ca
10.1
8.8
Hypokalemia
GFR
82
Microycytosis
Mag
1.3 L
DVT
Phos
3.5
Increased urine output
Total Pro
6.2 L
Fall 3 weeks ago
Album
3.0 L
Fall last year
A1C
12.2 H
Hysterectomy
Lower back pain
Medications:
Lower leg joint pain
Hospital Medications:
Arthritis
Enoxaprin (DVT) 40 mg q24h
Asthma
Gabapentin (pain management) 300 mg
Hypercholesteromia
q24h (nightly)
Denies current alcohol, tobacco, drug abuse
Insulin glargine (insulin) 30 units q24h
Hx of tobacco and alcohol use
(nightly)
Lisinopril (hypertension) 40 mg q24h
Symptoms
Magnesium oxide (hypomagnesia) 400
Increased urine output
mg q24h
Acute knee pain
Numbness
Diet History
Per pt, appetite has decreased over past two weeks,
stating she has lost 15 lbs over the past month or
so intentionally. Pt appetite has improved since
arrival at hospital and pain has decreased. Pts idea
of following diabetic diet is to tries to eat low
sugar foods. Pt did not know what a carbohydrate
was PTA. Pts daughter prepares meals at home
making chicken often, fried, baked or broiled. Pts
daughter also distributes and manages pt
medication. Pt states does not check BS as often
as I should.

Insulin lispro correction scale (insulin)

150-199 = 1 unit
200-249 = 3 units
250-299 = 5 units
300-349 = 7 units
>349 = 8 units
Metaprolol (hypertension and acute MI)
5 mg SBP>170 mmHg
Home Medications:
Insulin glargine 100 units/mL
Metformin
Ranitidine 150 mg oral
Sertraline 25 mg oral
Current Diet

Anastasia Maczko
Hospital: Cardiac, Med Carb
Home: low-sugar
Nutrition Diagnosis utilize PES Statements
NB-1.1: Food nutrition knowledge deficit related to lack of prior exposure to accurate nutrition
information; poor food choice aeb fs: 213, 337, 209 and A1C 12.2.
NI-2.1: Inadequate oral intake r/t decreased appetite aeb pt report of decreased PO intake PTA and
15-lb weight loss.
Nutrition Intervention Nutrition prescription, Interventions with goals
Nutrition Prescription
Intervention with goals
Cardiac, med carbohydrate diet (1800
Goal: Increase PO intake >75% of meals.
kcals, 87 g pro)
E-1.1 Nutrition Education
- Importance of diabetic diet
Mifflin St Jeor (1.2 AF): 1,207-1,335 kcal
- What a carbohydrate was
Protein Needs (based on IBW): 63-79 g pro
- What foods to eat/avoid
Fluid Needs: 20-25 mL/kg, 1,268-1,585
- Provided list of carbohydrate foods and
mL
serving sizes, taught comparison of food
size to hand
RC-1.4 Collaboration with other providers
- MD referral to Cigna Health Spring office
- Pt had ride and time pick up to meeting
- Pt told to bring all medications to have
reviewed
Maintain blood glucose of <160 mg/dL as medically
feasible.
Achieve normal electrolyte balance.
Eat >75% meals and/or supplements.
Understand diet education prior to discharge.
Nutrition Monitoring and Evaluation
Indicator
FH-1.1.1.1 Total energy intake
HF-4.2.7 Readiness to change nutritionrelated behaviors
BD-1.5.1, 1.5.3 Glucose fasting and A1C

Criteria
Pt receives appropriate diet order and carbohydrates
per day.
Pt consumes 75%+ of meals.
Pt eager to learn information, asked nutritionrelated questions related to her diet and received
verbal and documented education.
Monitor pt glucose and A1C levels.

*Med CHO diet provides 1800 kcal, 87 g protein, no fluid restriction

Source
Kcal requirements
Protein requirements
Facility standards
1,207-1,335 kcal (1.2
63-79 g protein

Fluid requirements
20-25 mL/kg (IBW 90-

Anastasia Maczko
activity factor)
EAL

Online nutrition care

manual

When possible use

indirect calorimetry, if
unavailable use Mifflin
st jeor
Use Mifflin st jeor with
1.3 sedentary activity
factor *Note UMH
uses 1.2 AF for
sedentary, 1,308-1,446
kcal/day

120%), 1,268- 1,585

mL

Pts over 65+ 1.0-1.25

g/kg/day

1 mL/kcal

References:
Academy of Nutrition and Dietetics. International Dietetics and Nutrition Terminology (IDNT)
Reference Manual. Chicago, IL: American Dietetic Association; 2013.
Academy of Nutrition and Dietetics. Nutrition Care
Manual. http://www.nutritioncaremanual.org. Accessed September 13, 2014.
Mahan, L. Kathleen., Sylvia Escott-Stump, Janice L. Raymond, and Marie V. Krause. Krause's
Food & the Nutrition Care Process. 13th ed. St. Louis, MO: Elsevier/Saunders, 2012. Print.