Running head: CASE STUDY 13

Lesson 13 Case Study

Implement Physicians Dietary Orders
Angela Martin
United States University

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Lesson 13 Case Study- Paige

Introduction
This case analysis is about Paige who is a long term care resident at Golden Arches
Nursing Home. She has a history of alcoholism, high blood pressure and malnutrition. Her diet
order is no added salt with ground meats. While in the nursing home she has eaten better until
recently. Her intake is less than 50% and she refuses her oral nutritional supplement. Her fluid
intake is less than 1000 ccs per day. The nurses suggested double portions and more oral
nutritional supplements. Paige has a feeder to assist her for lunch and dinner.
1. How old is Paige?
According to the information presented in the case study, Paige was born in 1932 and as
of today (2012) she is eighty years old.
2. Calculate her BEE
BEE = 65.5+9.56 (weight) + 1.85 (height) 4.68 (age) (Buchwald, Cowan & Pories, 2007)
BEE = 355.8
3. What is her percentage of ideal body weight?
Paiges Ideal Body Weight is 100 lbs based on the fact that she is currently weig80 years
old and her height is 4 feet 8 inches.
Percentage of Ideal Body Weight = Original Weight/ Ideal Weight * 100
Percentage of Ideal Body Weight = 75 / 100 *100
Percentage of Ideal Body Weight = 75%
4. What does the Physicians Diet Order mean for you? How would you implement it?
The term Physician diet order means customized diet plan involving dietary change to
improve health outcomes of client. I would implement it by first checking whether the diet order
id appropriate for Paige as a long term care resident. Then I will develop a menu for her and add
menu extensions as needed. After developing the menu, Paige and her family members will be
educated about the diet plan and later on I will take follow-up from Paige about the diet order.

CASE STUDY 13

5. Look at her lab report. What does it tell you about her iron status? What are normal
iron status lab values for adult females?
The problem of anaemia is the most intractable and common nutritional problems today.
The main reasons of anaemia are: inherited conditions (thalassaemia), deficiencies of key
micronutrients (Vitamin A, Vitamin B12 and flotae), schistosomiasis and hookworm infections,
malaria and most importantly dietary iron deficiency (Pinkney, Johnson & Gale, 2010). The
dietary iron deficiency is measured by evaluating patients iron status. Paiges iron status can be
evaluated by her HCT and HGB stats. The normal range of Hemoglobin for women is 12.1 to
15.1, and considering this Paige seems to have mild anemia as her Hgb is 9 g/dL. On the other
hand, normal range of hermatocrit is 38% to 46% for women and Paige is quite low at 30%
indicating that there are 30 milliliters of red blood cells in 100 milliliters of blood.
6. Paige is consuming around 1000 ccs of fluid per day. Calculate her fluid need. List three
ways to increase her fluid intake.
Base don the fact that Paige is 80 years old, her daily fluid need is 2500 ccs. Three ways
in which we increase her guild intake are:
Encouraging Paiges visitors and friends to have a drink with her or offer her drink.
Offering a full glass of water when giving medications and keeping a water jug close to

her bed.
Reminding or prompting Paige to start her meals with a glass of water.

7. Look at her blood pressure. What does it tell you about her risk for a stroke? What does
the medication she is on mean?
Considering the fact that Paige is 80 years old, her normal blood pressure should be
below 120/80 mmHg. Considering her lab reports, Paiges blood pressure is 150/100 mmHg
which means that she had high blood pressure. High blood pressure is considered to be one of the
most prevalent risk factor behind heart stroke. So Paige had at high risk for a stroke. Paige is
currently taking Lasix for her blood pressure twice a day. This medicine will treat fluid retention

CASE STUDY 13

and treat high blood pressure. Lasix mainly lowers a persons blood pressure and lower their risk
of a stroke or a heart attack.
8. Today her blood pressure is 190/120. The doctor changes her diet order to high calorie
(2000), 40 gr protein, 2 gm sodium restriction. Write a one day menu for this diet. Use the
AND (Academy of Nutrition and Dietetics, formerly known as the American Dietetic
Association [ADA]) Exchange lists to estimate protein and calorie content. See your
calculations for protein and calories. You may include an appropriate oral nutrition
supplement if you wish.

Portion
3
1 Cup
1 cup
1/2 Cup
4 Oz.
1/2 Cup

2000 Calories Diet

Breakfast
Calories Protein
Food
456
36
Boiled Eggs (Without Salt)
112
1.7
Orange Juice
22
1.7
Tossed Salad with Dressing (Low Salt)
Lunch
15
0.9
Green Beans
136
3.4
Whole Milk
107
2
Mashed Potatoes with chives
Homemade Chicken Fried Steak with

8 Oz.

498

42.55
seasoned vinegar

8 Oz.
Half Cup
1/2 Cup

440
55
15

64
0.43
0.9

4 Oz.
TOTALS

136
1992

3.4
157

Dinner
Baked Chicken with seasoned vinegar
Spinach Salad without salt
Green Beans
Bed Time
Whole Milk

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References

Buchwald, H., Cowan, G. S., & Pories, W. J. (Eds.). (2007). Surgical management of obesity.
Elsevier Health Sciences.