Chaya Wilhelm FNDH 632- Fall 2017

Case Study 2- Pancreatitis

Home Office
10/10/ 2017 3:05 pm
A: Todd presented to the ER with complaints of epigastric pain, nausea, and vomiting that began yesterday. States
he has a significant hx of pancreatitis. He recently returned from a vacation to CanCun and reported “excessive
ETOH intake while there.” On a normal basis, patient reports frequent ETOH intake daily, about 2-3 beers daily
and hard liquor on the weekends. Todd currently rates his pain at an 8 or 9 on scale of 1-10. He reports the pain is
dull, aching in epigastric region and is very similar to pancreatic flares.
Patient is positive for HTN and pancreatitis with his last episode two years ago. He denies any surgical history,
smoking, or drug use.
32 year-old male, Caucasian
Ht: 70” Wt: 226 # BMI: 32.4 (Obese)
Diet Order: Keep patient NPO, then advance to clear liquids, and then DAT of high protein, high fiber, low fat,
nutrient-dense foods. Small frequent meals recommended.
EER: 2600 kcal (Mifflin and kcal/kg) Protein Needs: 154 g/day (1.5 g/kg bw)
Vitals: BP 140/92, HR 70s and regular, RR 18, normal rate of breathing and effort. Temp 98.4, Ox saturation
98% on room air.
General: alert, age appropriate, very uncomfortable in appearance
HEENT: Head: Normocephalic. ENT: Unremarkable
Chest: lungs clear bilaterally Cardiovascular: heart strong and regular Bowel sounds are normal
Abdomen: soft, positive bowel sounds, moderate tenderness with mild epigastric guarding without rebound.
Neurological: motor and sensation are intact without edema noted in extremities. Cap refill is less than 2.
Labs: White Count (14.2), Hgb (14.4), CO2 (30.5), Glucose (112), Lipase (3226), Amylase (240), ALT (66), and
hsCRP (12) are high.
Medication: Lisinopril, Fentanyl, Zofran, and Morphine
D: PES Statement #1: Impaired nutrient utilization (NC-2.1) related to compromised pancreatic function as
evidence by increased amylase, lipase, and many other lab values.
PES Statement #2: Food and nutrition related knowledge deficit (NB-1.1) related to patient’s pancreatitis
diagnosis and history as evidence by his excessive alcohol intake.
I: Intervention #1: Increased protein diet (NC-1.2.3.1), Increased fiber diet (ND-1.2.7.1), and decreased fat diet
(ND-1.2.5.2)- When starting a normal oral diet, it is important for pancreatitis patients to eat high protein, high
fiber, low fat, nutrient-dense diets that include fruits, vegetables, whole grains, low fat dairy, and other lean
protein sources.
Intervention #2: Purpose of the nutrition education (E-1.1)- Educate patient on recommended alcohol guidelines
M/E:
• Types of food/meals (FH-1.2.2.2)
• Alcohol Intake (FH 1.4.1)
• Total Fat (FH-1.5.1.1)
• Total Protein (FH- 1.5.2.1)
• Total Fiber (FH-1.5.4.1)
• Areas and level of knowledge/skill ( FH-4.1.1)
• Amylase (BD-1.4.12)
• Lipase (BD- 1.4.13)

Chaya Wilhelm
Future RDN, LD