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2. Identify which of these may affect cardiac function, liver function, and renal function.
Metabolic alkalosis can affect renal function because the kidneys compensate for increased alkalinity by
producing more hydrogen ions and increasing reabsorption of bicarbonate. Metabolic alkalosis can affect
cardiac function because it affects potassium levels, which regulate heart contractions. If left untreated,
severe metabolic alkalosis can lead to heart failure. Chronic dehydration can affect renal function because
fluid imbalance is regulated by the kidneys to maintain blood volume. Dehydration affects electrolyte status
and blood osmolality. A change in plasma concentration above 290mOsm signals the hypothalamus to trigger
the pituitary gland to release the antidiuretic hormone (ADH), so more water can be reabsorbed bythe
kidneys. Dehydration can also decrease blood volume, which decreases blood pressure, which in turn can
impact cardiac function.
3. Are there also normal changes in renal function that occur with aging?
Yes, changes in renal function occur as people age because the kidney nephrons decease in size and number,
causing the kidney to shrink. Kidney tubules also become less effective. Atherosclerosis, common in the
elderly, can also narrow the renal arteries decreasing kidney function. In fact, by age 80 the GFR is decreased
by approximately half compared to that of a young adult. Chronic diseases such as diabetes, which become
more likely as one ages, also affect renal function.
4. Define polypharmacy. Do you think that Mr. Kaufman’s medications represent polypharmacy? Why is
polypharmacy a concern in the elderly?
Polypharmacy is taking multiple medications concurrently. Polypharmacy is also associated with taking
multiple medications to treat the same condition, taking a medication that is not needed, using improper
dosage, taking a medication to combat another medication’s side effects, and drug-drug interactions.
There is currently no strict guideline on the number of medications, but Mr. Kaufman is taking eleven
medications, which definitely indicates polypharmacy.
Polypharmacy is a concern to elderly because they have high rates of chronic disease and usually take
multiple medications. As people age, cardiac, liver and renal functions decline and lean body mass decreases,
changing the person’s body composition. These physiological factors alter how the body absorbs,
metabolizes and excretes the medications. Lastly, the elderly are more inclined to take the medications
improperly for various reasons: forgetting to take medication, misunderstanding directions, inability to afford
medications, and inadvertently taking additional doses due to forgetting that the first dose was taken.
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saliva production, and alter the sense of taste and smell. All of these factors can disrupt eating habits and
affect nutrient intake. Medications can alter the pH of gastric juices, increase the transit time of nutrients,
cause gastric emptying, or have side effects like nausea, vomiting, diarrhea and constipation that can affect
the absorption of certain nutrients by not providing adequate time or an appropriate metabolic environment
for absorption in the GI tract. Medications can interfere with the nutrient metabolism through various
mechanisms, such as competing for cell binding sites and increasing metabolic processes. Most medications
are excreted by the kidneys in urine, so medications that increase urination can also increase the excretion of
nutrients. Some medications also alter renal function, affecting reabsorption of the medication and nutrients.
8. Calculate Mr. Kaufman’s percent usual body weight. Interpret the significance of this assessment.
Mr. Kaufman’s daughter reports that he weighed 225 lbs. three years ago when he moved in with her but
that his weight has been stable for the past year. Mr. Kaufman’s usual body weight is reported as 195-225 lbs.
%Weight Change = [(UBW-ABW) / UBW] x 100%
[(195-196)/195] x 100% = 0.5% weight gain
[(225-196)/225] x 100% = 12.9% weight loss
Mr. Kaufman’s weight change ranges from 12.9% weight loss to 0.5% weight gain. Given the family
interview and patient history, these changes are not significant. The 12.9% weight loss seems to have
occurred over a two-year time frame, which is not significant and is beneficial given his classification as
obese and his diagnosis of type 2 diabetes and hypertension. His weight has been stable for the past year with
only 0.5% (1 lb.) increase, which is not significant.
9. When completing a nutritional assessment on an older individual, should specific changes in body
composition and energy requirements be considered? If so, which changes?
Yes, body composition and energy requirements need to be considered when completing a nutritional
assessment on an elderly person. As people age, their lean body mass decreases and body fat increases. Lean
body mass is more metabolically active and requires more energy than adipose tissue. Elderly require less
energy because they are typically less active and more sedentary, and have lower metabolic demands due to
their body composition. In Mr. Kaufman’s situation, he is obese and should lose weight. After using
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evidence-based calculations to estimate energy needs, like the Mifflin-St. Jeor equation, the estimate may
need to be lowered for weight loss to occur.
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Based on Mr. Kaufman’s usual dietary intake, he is consuming approximately 1500-1700 calories and
approximately 121 g. protein per day. Based on MyPlate’s Supertracker recommendations, he should be
consuming 1800 calories and 56 g. protein per day. Current MyPlate recommendations for a man 51 years or
older is to consume 2 cups of fruit, 2½ cups of vegetables, 6 oz. of grains, ½ of which should be whole-grain,
5½ oz. of protein and 3 cups of dairy. Based on these recommendations and his usual dietary intake, Mr.
Kaufman is consuming inadequate amounts of fruits, vegetables, dairy and possibly whole-grains but excess
protein. I would recommend that Mr. Kaufman increase his fruit, vegetable and dairy consumption and
decrease his protein intake. I would also suggest that he consume whole-grain bread and pasta and brown
rice, if he is not already doing so.
14. What laboratory values support his medical history of renal insufficiency? What laboratory value(s)
support this diagnosis of metabolic alkalosis? Which are consistent with dehydration? What laboratory
values support his medical history of type 2 diabetes mellitus? Use the table below to indicate the
various diseases/conditions.
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15. Using the following table, list all the medications that Mr. Kaufman was taking at home. Identify the
function of each medication and any potential drug-drug or drug-nutrient interactions.
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Medication Function Drug–Drug Interaction Drug–Nutrient
Interaction
Aspirin Analgesic, NSAIDs Avoid or limit:
Anti-pyretic, Methotrexate Garlic
Anti-arthritic, SSRIs Ginger
NSAID, Anticoagulants Gingko
CVA or MI prevention Anti-hypertensives, diuretics & Ginseng
Platelet aggregation inhibitor ACE inhibitors, including Diovan Horse
NPH & regular insulin chestnut
Sodium bicarbonate
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