.

'

Nutr 302l MYH Nutrition Experiment: HDL and LDL Nutrition Assessment Diagnosis: Coronary artery bypass graft Age, gender: 54, female Dietary intake: PO intake Smokes 2 pks/day Consumes high fat diet, no physical activity Family history of heart disease Anthropometric Measurements o Ht/wt: 5'4"/162.6 cm and 148#/67.1 kg o BMI= 25.6 kg/ m2 (overweight). o IBW= 120#/54.4 kg, %IBW=123% (obese) Energy, o o o Care Process Recorder: Aubreyann Veyveris

Date: 14 March 2013

protein, and fluid needs Total energy= 2858- 3266 kcal/d Protein= 83.9-100.7 g/d Fluid= 2858-3266 ml/d For energy, used Mifflin St. Jeor formula to determine activity factor (1.3) and injury factor (1.75-2) For protein, used surgery-range of 1.25- 1.5 g PRO/kg For fluid needs, used 1 ml/kcal/d

REEthen multiplied

by

Lab/tests o AST: 76 U/L, high (10-34 U/L) o ALT: 31 U/l, normal 8-40 U/L) o LDH: 322 U/L, high (85-285 U!L) o CPK: 268 U/l, high (24-195 U/L) o Bilirubin (total): 0.5 mg/dl, normal (0.2-1.4 mg/dl) o o o o o Bilirubin (direct): 0.1 mg/dl, normal (0-0.4 mg/dl) Triglycerides: 250 mg/dl, high 150 mg/dl) Total cholesterol: 240 rng/dl, high 200 mg/dl) HDL: 34 rng/dl, low ( >50 mg/dl) LDL: 156 mg/dl, high 130 mg/dl)

Nutrition Diagnosis

Undesirable food choices R/T high fat diet preference AEB high triglyceride, and LDL levels, and low HDL levels in the blood.

total cholesterol,

Nutrition Intervention 1. 2. 3. Meal and Snacks a. Develop a 7 day low fat meal plan Nutrition Counseling a. Counseling on low fat foods, kcal value Coordination of Nutrition Care a. Refer to exercise specialist after rehab

r:

b. Goals 1. 2. 3. 4.

Referral to smoking cessation class

c-:

---

Normalize TG, Total Cholesterol, HDL, and LDL levels.within Quit smoking as soon as possible Change food habits, lower fat diet after rehab Develop regular exercise pattern within 2 wks

3 months

Monitoring and Evaluation

Follow up phone call within 1 wk -Ask the patient to do a 3 ggy..food record and bring to clinic to reassess kcal and fat intake Re-evaluate TG, total cholesterol, within normal range HDL, and LDL levels in the lab in 3-4 months to determine if

Experiment: Blood albumin Nutrition Assessment

Nutrition Care Process Date: 217/13 Recorder: Aubreyann Veyveris

Diagnosis: Bladder cancer Age, gender: 55, female Dietary intake: PO intake Symptoms: Decreased appetite since chemo, NN when tries to eat 30 g/d protein intake Anthropometric measurements o Ht/wt: 5'5"/ 165.1 em and 112#/ 50.9kg o BMI= 18.7 kglr02 (normal) o mw= 125#/56.8 kg, %mw= 89.6% (mild malnutrition) o UBW= 123#/55.9 kg, %UBW= 91% (mild malnutrition) o % wt loss: 8.9% (mild degree of malnutrition

Energy, protein, and fluid needs Total energy= 1998-2306 kcal/d Protein= 50.9-63.6 g/d Fluid= 1782 mlId o For energy, use Harris- Benedict formula to determine REE then multiply by activity (1.3) and injury factor (1.3-1.5) /' o For protein, used stress factor for tumor: 1.0-1.25 g PROlkg ,./ o For fluid needs, used 35 ml/kg/day Labs/tests o Total PRO= 5.5 gldL, low 6.0 gldL) o Serum albumin = 2.8 g/dl., low 3.8 g/dl.)

Nutrition Diagnosis

Inadequate protein intake (or inadequate energy intake) RlT poor appetite and NN caused by chemotherapy / AEB <90% mw, 8.9% wt loss, low protein intake (30 g/d), low total protein and low serum albumin.

Nutrition Intervention 1. Meals and Snacks a. Supplement protein drinks Till between meals / b. Protein rich foods- soy, whey, beans, legumes, chicken, cheese, eggs 2. Nutrition-related medication management a. REC appetite stimulant Goals 1. 2. 3. 4. Dietary intake to meet >75% of estimated energy needs Weight gain of 1#/wk until pt reaches UBW/mW Protein need: 50.9-63.6 g/d Increase total protein and serum albumin to within normal ranges in 4 wks

Monitoring and Evaluation

./

Follow up phone call within 1 wk Ask the patient to do a 3-day food record and bring it to the clinic to reassess BW, protein intake have increased from previous visit. Re-assess total protein and serum albumin in 4 wks to determine if within normal ranges. Consult MD if the patient need a TPN in case the patient has still low blood albumin and loses body weight

Nutr 302L MYH Nutrition Care Process Experiment: Blood Glucose Nutrition Assessment Diagnosis: Type I Diabetes Mellitus Age, gender: 24, male Dietary Intake: PO intake Symptoms: Frequent urination, excessive thirst and hunger Low exercise, checks blood sugar 1 or 2 times a week, meals consist of soda, hamburger, fries, frozen pizza, dessert Anthropometric measurements o Ht/wt: 5'10"/177.8 cm and 165#/74.9 kg o BMI= 23.7 kg/ m2 (normal) ~ o IBW= 166#/75.3 kg, % IBW= 99% (ideal) Energy, protein, and fluid needs o Total energy= 1818-2363 kcal/d C"1 G1. o Protein= 59.9- 74.9 g/d o Fluid= 2622- 2996 ml/d For energy, used Harris-Benedict formula to determine REEthen multiplied by activity factor (1.3) For protein, used non-stressed range of 0.8-1.0g PRO/kg For fluid needs, used range of 35-40 ml/kg/day Date: 12 February 2013 Recorder: Aubreyann Veyveris

Labs/tests o Glycosylated hemoglobin: 9.4%, high 6.5-7%) o Fasting blood glucose level: 180 mg/dl, high ( 70-110 ml/dl) o Hgb= 14.7 g/dL, normal (13-18 g/dL) -, o Hct= 44%, normal (38-52%) o Albumin= 4.5g/dL, normal (3.5-5.0 g/dt,

Nutrition Diagnosis Limited adherence to nutrition-related recommendations R/T consumption of poor diet for a ~ diabetes patient, limited amount of exercise, and lack of blood glucose monitoring AEB excessive hunger and thirst, a HbAlc of 9.4% and a fasting blood glucose level of 180 mg/dl. ~

Nutrition Intervention 1. Meal and Snacks a. Modify distribution, type, or amount of food and nutrients within meals at a specified time- 34 small meals a day plus snacks and counting carbs i. Examples of foods- fruit, eggs, yogurt, whole wheat bagel, veggies, turkey sandwich on whole wheat bread, chicken breast, almonds, apple, carrots- lots of fruits and vegetables and whole grains ~ Coordination of nutrition care a. Nutrition counseling-carb counting, blood glucose monitoring b. Refer to diabetes specialist / c. Refer to exercise specialist- develop regular pattern of exercise

2.

Goals 1. 2. 3. 4. Develop immediate habit of self monitoring of blood glucose levels 3- 4 times daily Lower glycosylated hemoglobin in 3-4 months <6.5- 7% Vl f'VWl bLI Establish regular exercise pattern within 2 wks Count carbohydrates within 1 wk

+'1

Monitoring and Evaluation Follow up phone call within 1 wk Ask the patient to do a 3 day food record and bring it to clinic to reassess food habits and diet Re-evaluate glycosylated hemoglobin in lab in 3-4 months to determine if within normal range

Nutr 302L MYH Experiment: Hemoglobin/Hematocrit

Nutrition Assessment

Date: 2/14/13

Recorder: Aubreyann Veyveris

Age, gender: 22, female Dietary intake: PO intake Symptoms: exhaustion Breast-feeding, lacto-ovo vegetarian Stopped taking vit/min supplement Anthropometric o o o measurements Ht/wt: 5'4/1/ 162.6 cm and 108#/49.0 kg BMI= 18.5 kg/m2 (normal) IBW= 120#/54.4 kg, % IBW= 90% (mild malnutrition)

Energy, protein, and fluid needs

Total energy= 2,106 kcal/d Protein=64.2-74.0 g/d Fluid= 2106 ml/d o o o For energy, used Mifflin-St. Jeor formula to determine REEthen multiply by activity (1.3) and add 500 kcal for lactating For protein, used non-stressed factors of 0.8-1.0 g/kg and added 25g for lactation For fluid needs used lml/kcal/d Hemoglobin: 9.5g/dl, low (11-16 g/dl) Hematocrit: 30%, low (37-47%)
.~

Labs/tests o o ~

JA'if
(lV1

Nutrition

Diagnosis

VePl ~~t'

G\fRf .

Nutrition

Inadequate energy intake R/T lactating, refusal of vit/min supplement, and no ~~Jt in diet AEB 90% IBW, low hemoglobin level of 9.5 g/dl, and low hematocrit level of 30%.
Intervention

1.

Meals and Snacks a. b. Increase kcal intake Increase iron rich foods- spinach, nuts, eggs,beans Nutrition counseling-lactation Start vit/min supplement immediately

2. 3.

Nutrition Education a. a. Nutrition related Medical Management

Goals 1. 2. 3. Increase hemoglobin/hematocrit Begin dietary supplementation levels in 3-4 mnths immediately

N C VrvtoJ

\U

Consume more nutrient dense foods, > 95% of kcal DRI to increase energy intake

Monitoring and Evaluation

Follow up phone call within 1 wk Ask the patient to do a 3 day food record and bring to clinic to reassess consuming iron rich and nutrient dense foods Schedule a follow up appointment in 3-4 months to re-assess hemoglobin and hematocrit levels and determine if within normal ranges

NCP Note: Anthropometric Veyveris Subject gender: Female Subject age: 28 1. Ideal Body Weight Weight: 140 #/2.2=63.6 kg

Lab

Date: 21 March 2013

Recorder: Aubreyann

Height: 65 in x 2.54=165.1 em Elbow breadth: 2.2 in x 2.54= 5.7 em Frame size: small Life Insurance Table Weight Range: 127-141 #, 58-64 kg Hamwi IBW: 100 +25 = 125#

% IBW: 112% (overweight)

Comment: Subject's actual weight is within the life insurance table weight range of 127-141; however, the %IBW suggests the subject is slightly overweight. 2. Body Mass Index BMI: 63.6/ (1.65)2 = 23.4 kg/m2 Category: Normal 3. Waist to Hip Ratio Waist: 74cm Hip: 99 cm Waist to Hip Ratio: 74/99= 0.7 Comment: Subjects value of 0.7 is below the preferred value for a female of <0.8. 4. Arm Circumference and Triceps Skinfold Comparison

Triceps: 16 mm,

zs" %ile
300 mm

Mid-arm circumference:

Arm muscle area: 4200 mm2, Total arm area: 7200

so" %ile

Arm Fat Area: 7200- 4300= 2900 mm2, 60th%iJe 5. Body Composition

A. Circumferences Abdomen constant Thigh constant Subtotal Constant Subtotal 33.5

28.5 62.0 22 40 20

Approximate

body fat: 20%

B. Bioelectrical Impedance Analysis (BIA) Body fat: 140 # x, 221= 31#, 22.1 % /

C. Three and Seven Site Skinfolds Three Site Skinfold Triceps: 16, 17, 17, 17 Mean: 16.75 Suprailiac: 11,10,10,9 Mean: 10.13 Thigh: 23,25,27,27 Mean: 25.5 Sum: 52.38 Seven Site Skinfolds Chest: 7,7,7,7 Mean: 7 Midaxilary: 8,7,8,8 Mean: 7.75 Triceps: 16,17,17,17 Mean: 16.75 Subscapular: 9,9,9,9 Mean: 9 Abdomen: 19,20,20,19 Mean: 19.5

'1..1,-

Suprailiac: 11,10,10,9 Mean: 10.13 Thigh: 23,25,27,27 Mean: 25.5 Sum: 95.6 '"

3
+ 0.0000023(52.38)1\2 -

Body density from 3 skinfold sites: 1.0994921 +0.0009929(52.38) 0.0001392(28) = 1.05 Body density from 7 skinfolds sites: 1.09700000-0.00046971(95.6) 0.00012828(28) = 1.05 Three Site Skinfold Body Composition Results Body fat: 63.6 kg x .214= 13.6 kg, (495/1.05) - 450= 21.4% Lean body mass: 63.6-13.6= 50kg, 100-21.4= 78.6% Seven Site Skinfold Body Composition Results Body fat: 63.6 kg x .214= 13.6 kg, (495/1.05)-450= 21.4% /
.--.~-.-~

=0.00000056(95.6)1\2-

... ..."-

Lean body mass: 63.6 kg-13.6 kg- 50 kg, 100-21.4= 78.6%

"

D. Hydrostatic Weighing (gold standard to estimate body fat) Residual Volume (RV): 29.3(165.1 cm) + 7.6 (28)-3730= 1.32 Trial #1: 2, Trial #2: 2.2, Trial #3: 1.9 Avg: 2.03 (UWW) Body density: 63.6/[ (63.6-2.03)/0.99567) -1.32] = 1.05 21.4%

Body fat: 63.6 kg x .214= 13.6 kg, (495/1.05)-450=

C: '7, 0\ ,,..' y \

t))~

Lean body mass: 63.6kg-13.6kg= 50kg, 100-21.4= 78.6% Comment: The four above methods to determine percent body fat yielded n bers that were all very similar to each other. The hydrostatic weighing, which is the gold standard to estimate body fat gave us an answer of 21.4% body fat and the three and seven sitesRififolds tests also gave us the answer of 21.4% body fat for our subject. The bioelectrical impedance analysis had a ~Iightly higher value of 22.1% body fat. However, this number could be altered based upon how much water our subject drank before the test was administered. On the other hand, the basic body composition formula gave us a slightly lower value of 20% body fat. Seeing that all four of these results are within a small range of each other, the subject's percent body fat is most likely around 21%. While, all four tests have their strengths and limitations it is clear that they all give a fairly accurate result of percent body fat, plus or minus a few percents.

Y Q:WLl

V'{'. 'b~
~

wt\\m S~TVl~
DV"J '. Y' V'yYV'tJ
\V\b~
I.

~.

Ui-wA vt 9>'1 6'tJ .

Nutrition Experiment: Diet Lab Nutrition Assessment Age, gender: 21, female Dietary intake: PO intake Activity level: moderately active Date: 12 March 2013

Care Process Recorder: Aubreyann Veyveris

Anthropometric measurements o Ht/wt: 5'6/1/167.6 cm and 129#/58.5 kg o BMI= 20.8 kg/m2 (normal) o IBW= 130#/59.0 kg, %IBW= 99% (ideal)

Table 1. Nutrient Intake Data for 24-hour Recall Energy (kcal) Recall 1792.2

...-- .
Pro (g) 47.8 Vit.A (ug) 950.9
1.

CHO (g) 272.6

Fiber (g) 30.9

@Z
569.1

Fat

Sat. Fat@
)

Vito D (ug) 3

Vit.C (ug) 106.7

Iron (mg) 27.7

Calciu m (mg) 709.6

Sodium (mg) 2199.9

120.3

(~
ORI %DRI 2450.1 73.2 low 336.9 80.9 low 34.4 90.2 low

~)
220.5 46.8 102 ok 700 135.8 high 15 20 low 75 142.3 high 18 153.7 high 1000 71.0 low 2300 95.7 ok

686.0 83.0 low

54.5 low

Nutrition

Diagnosis Inadequate vit. 0 and calcium vitamin and mineral intake R/T limited consumption mg. of vlt. 0 and

calcium rich foods AEB 24 hr recall data 3ug Vito 0 vs ORI of 15 ug and 709.6 mg calcium vs ORI of 1000

Nutrition 1. 2.

Intervention Meal and Snacks a. Consume more vit, 0 and calcium rich foods- examples= milk, yogurt, low fat cheese, fish, egg Supplements a. Begin taking a vit/min supplement with adequate levels of vlt. 0 and calcium

Goals 1. 2. Take vit/min supplement daily in order to reach ORllevels

Consume more vit, 0 and calcium rich foods immediately and Evaluation

Monitoring

Follow up phone call within 1 wk Ask the patient to do a 3 day food record and bring to lab to reassess food habits and diet
Revisit lab two weeks later for follow up session

Nutr 302L MYH Nutrition Experiment: Triglyceride Nutrition Assessment Care Process Recorder: Aubreyann Veyveris

Date: 7 March 2013

Diagnosis: Type II Diabetes Mellitus Age, gender: 37, female Dietary intake: PO intake No physical activity, currently eats a high fatty diet Anthropometric measurements o Ht/wt: 5'1"/154.9 cm and 152#/ 69.1kg o o o BMI= 28.8 kg/m2 (overweight) IBW= 105#/47.7 kg, % IBW= 145% (obese) Adjusted body weight = 117#/53.2 kg /'

Energy, o o o

protein, and fluid needs Total energy= 1325-1590 kcal/d Protein= 42.4-53.0 g/d Fluid= 1325-1590 ml/d /' For energy, kcal intake based on adjusted body weight and range of 25-30 kcal/kg For protein, used non-stressed range of 0.8-1.0g PRO/kg For fluid needs, used 1ml/kcal/d

Labs/tests o Albumin: 4.2 g/dl, normal (3.5-5.0 g/dl) o Hgb= 13.4 g/dl, normal (13-18 g/dl) o Hct= 41%, normal (38-52%) o Blood glucose= 145 mg/dl, high (70-110 rng/dl) o Blood triglyceride= 250 mg/dl, high 150 mg/dl)

Nutrition Diagnosis Overweight/obesity R/T no physical activity and excessive fat intake AEB a blood glucose level of level of 250 rng/dl, a BMI of 28.8, and 145% IBW.

145 mg/dl, a blood triglyceride Nutrition Intervention 1.

2.

Meal and Snacks a. Develop a 7 day meal plan considering lifestyle and activity choices with a new kcal intake range Nutrition Counseling a. How to lose body weight by lowering kcal intake of Nutrition Care

b. Education of basic diabetes info

3. Coordination a. Goals 1. 2. Lower kcal intake i~ly by meeting. range of daily kcal intake provided Lower blood glucose and triglyceride levels back to normal within 3-~months Refer to exercise specialist- develop regular pattern of exercise

---""

I
3. 4. 5. Daily blood glucose check~..:~.~s a day Lose body wt, 1-2# a week untillBW or. BMI back to normal range Develop regular exercise pattern within 2 weeks Monitoring and Evaluation Follow up phone call within 1 wk Ask the patient to do a 3 day food record and bring to clinic to reassess kcal intake Ask the patient to keep ~~Io~t~~ d measure bodyweight every day at same time every day to determine if within Re-evaluate blood glucose and triglyceride normal range levels in lab in }-4 months

Nutr 302L MYH Nutrition Experiment: Calcium Nutrition Assessment Age, gender: 67, male Dietary intake: PO intake Lactose Intolerant Consumes high protein diet- 150 g/day Anthropometric o o o measurements Date: 9 April 2013 Care Process Recorder: Aubreyann Veyveris

Ht/wt: 5'8"/172.7 cm and 166#/75.5 kg BMI= 25.3 kg/m" (overweight) IBW= 154#/70 kg, %IBW= 107% (overweight) Total energy= 1765-2157 kcal/d Protein= 60.4-75.5 g/d Fluid= 1765-2157 ml/d For energy, used Harris Benedict formula to determine activity factor (1.3) For protein, used non-stressed range factors of 0.8-1.0 g/kg For fluid needs, used 1ml/kcal REEthen multiplied by

Energy, protein and fluid needs o o o

./

Labs/tests o o o o o o Albumin: 3.8 g/dl, normal (3.5-5.0 g/dl) Glucose: 112 mg/dl, high (70-110 mg/dl) Cholesterol: 188 mg/dl, normal 200 mg/dl) Triglycerides: 89 mg/dl, normal 150 mg/dl) Serum Ca: 9.8 mg/dl, normal (8.5-10.5 mg/dl) Urinary Ca: 300 mg/day, high (100-240 mg/day)

Nutrition Diagnosis Imbalance of nutrients R/T lactose intolerance g/day of protein. Nutrition Intervention 1. Meals and Snacks a. b. 2. a. Consume more non-dairy calcium rich foods- examples: spinach, kale, salmon, tofu, nuts, broccoli Consume less protein- 60.4-75.5 g/day only Begin taking a low dose calcium supplement of 500 mg/day Supplements (no dairy consumption) and a high protein diet

AEB high urinary calcium level of 300 mg/day and a protein intake of 150 g/day vs a DRI of 60-75

3.

Coordination a.

of nutrition

care

Counseling on risk factors of consuming a high protein diet with a lactose intolerancehow to meet DRI for protein

Goals 1. 2. 3. 4. Begin to consume non-dairy calcium rich foods immediately Take dietary calcium supplement normalize Reduce protein intake to DRllevels of 60.4-75.5 gfday immediately Re-assess urinary Ca levels in 2 wks to see if within normal range of 100-240 mg/day of 500 mg/day immediately until urinary calcium levels

Monitoring and Evaluation Follow up phone call within 1 wk Ask the patient to do a 3 day food record and bring to clinic to reassess protein and calcium intake Re-evaluate urinary calcium levels in the lab in 2 wks to determine if within normal range