NTDT 450

ADIME: Case Study # 11

Pt. Name: Clarke, Alicia Date: 3/30

Overview: 42 y/o female presented to outpatient gastroenterology clinic with stomach and
intestinal complaints. Referred by family physician after being assessed with no findings.

Assessment
Client History: Divorced Kindergarten teacher with 2 children, works 8am-4pm during week,
lives with 2 children and mother
Medical Hx: hypothyroidism, GERD, obesity, meets criteria for IBS
Colonoscopy negative for disease
Negative stool cultures
Surgical Hx: C-section x 2
Tobacco use: 1 ppd x 10 yrs; quit at age 30
Alcohol use: 3-4 x per wk.
Family Hx: Father HTN, atherosclerosis; Mother, sister hypothyroidism, T2DM

Food and Nutrition Related History:

Appetite good even with abdominal pain and diarrhea
Gained 20+ lbs. over last 5 yrs.
Likes to cook and prepare most foods at home
Following high fiber diet as to help GI symptoms; gassy after some foods (broccoli and
cauliflower)
FODMAP assessment indicates high intakes of FODMAP foods
AM: homemade yogurt smoothie OR cereal with 1 c. fresh fruit, 2-3 c. coffee w/ half and
half and artificial sweetener
Mid-Morning: diet pepsi, c. dried fruit and nuts
Lunch: salad w/ kidney beans or lentils, cheese, tomatoes, carrots, asparagus; wheat
crackers (approx. 12-15), diet pepsi
PM: meat, pasta or potatoes, variety of veggies, roll w/ butter
Snacks: ice cream, cake, cookies (usually each night, has been trying to eat sugar-free),
wine or beer 2-3 x per wk.

Anthropometric Measurements:
Height: 55
Weight: 191 lbs.
BMI: 31.8 (obese)
IBW: 125.4 lbs.

Biochemical Data, Medical Tests, and Procedures:

Lab Results 3/30:
Glucose: 115 (H)
 Cholesterol: 201 (H)
HDL-C: 42 (L)
LDL: 122 (normal)
Triglycerides: 181 (H)
HbA1C: 6.1 (H)
Possible diagnosis for pre-diabetes
Medications at home: Omeprazole, Levothyroxine, Vitamin D, Calcium, Lomotil
Medications given in clinic: Elavil, Metamucil, Lomotil
Plan per MD:
Lab for hydrogen breath test, anti-tTG

Nutrition Focused Physical Findings:

Per nsg:
Abdomen: Hyperactive bowel sounds x 4; no organomegaly or masses lower abdominal
tenderness

Comparative Standards:
EER: (Mifflin x 1.1): Current body weight: 1532 kcals/day
Protein needs: 69 g/day (.8 g/kg, current body weight)

Diagnosis
Inappropriate intakes of types of carbohydrate (fructose and oligosaccharides) as related to
limited understanding of appropriate food intake for reported IBS symptoms as evidenced by
food recall of consumption of high amounts of FODMAP foods.

Intervention
Carbohydrate-modified diet (Reduce FODMAP and Lactose)
Prescription:
Patient will eliminate intake of fermentable oligo-di-and monosaccharides and polyols in
diet for 2 weeks in order to alleviate IBS symptoms.
FODMAP foods will slowly be added in after 2 weeks until tolerated limit is reached.
Foods to monitor include fruits, dried fruits, fruit juice, fructose, high fructose corn syrup,
honey, coconut, fortified wines, onion, leek, asparagus, artichokes, cabbage, Brussel
sprouts, beans, legumes, sorbitol, mannitol, isomalt, and xylitol.
Recommendation:
Provide nutrition education on FODMAP foods and the affects that they have on IBS so
that patient knows what foods to eliminate and why.
Recommend nutrition modifications.
Suggest food record to be kept to be reviewed at first follow-up visit.
Goal:
Patient will avoid FODMAP foods by normalizing eating patterns and ensuring adequacy
of all nutrients.
Consider use of prebiotics and probiotics.
Monitoring and Evaluation
Indicator:
Food intake (types of food/meals)
 Level of knowledge
Criteria:
Assess patients IBS symptoms (abdominal pain, diarrhea) based on new food intakes.
Evaluate knowledge based on patient food record.