NCP Notes

Kerry Linne
2/12/17
N302L Case Studies
Nutrition Care Process (NCP): Albumin
Nutrition Assessment
 Diagnosis: Bladder cancer

 Nutrition- related PMH, treatments, surgeries: Chemotherapy
 Age, Gender: 55, female
 Dietary intake: PO intake
 Food preferences, allergies, intolerances: None known
 Exercise habits: None known
 Knowledge, readiness for change: seeks aid in keeping food down
 Functional/behavioral factors: Unknown
 Resources for obtaining, preparing food: Unknown
 Symptoms: Nausea, vomiting, lack of appetite
 Anthropometric measurements
o Ht/wt: 65 in/ 165.1 cm and 112 lbs/ 50.8 kg
o BMI: 18.7 kg/m^ (normal)
o IBW= 125 lbs (mild malnutrition)
 5’=100#, 5’’x5#=25, 100+25=125 lbs
 112#/125#= 0.896 x 100= 89.6% (mild malnutrition)
o UBW= 123 lbs (mild malnutrition)
 112/123= .91x100= 91.1%
o % Weight loss= 8.9% (mild degree of malnutrition)
Energy, protein and fluid needs
 Total Energy= 1998-2306 kcal/day

o Used Harris-Benedict formula to determine REE then multiplied by activity
(1.3) & injury factor (1.3-1.5)
 Protein= 50.9-63.6 g/day
o Used stress factor for tumor: 1.0-1.25 g Pro/kg
 Fluid= 1.8 L/day
o Used 35 ml/kg/day
Labs/tests- can indicate high or low, normal or abnormal
 Total PRO= 5.5 g/dL, low (<6.0g/dL)

 Serum albumin= 2.8 g/dL, low (<3.8 g/dL)
 Glucose: 83 mg/dl
 Bun: 15 mg/dl
 Hgb: 12.2 g/dl
 Hct: 37%
Medications/supplements: Chemotherapy
Nutrition Diagnosis- PES format
 Inadequate protein intake related to poor appetite and nausea/vomiting caused by

chemotherapy (AEB) <90% IBW, 8.9% weight loss, low total protein (5.5 g/dL) and
low serum albumin (2.8 g/dL).
Nutrition Intervention
 Meals and snacks
o Breakfast- fruit smoothie with protein powder
o Lunch- quinoa salad with lean protein (fish or chicken)
o Dinner- Brown rice, roasted vegetables, lean protein
o Snacks- almonds, protein bars, protein shake
 Nutrition-related medication management
o REC appetite stimulant
Goals
1) Dietary intake to meet > 75% of DRI needs
2) Weight gain of 1 pound per week until reaching UBW/IBW
3) Increase total protein and serum albumin to normal ranges
Nutrition Monitoring and Evaluation
1) Keep dietary food log
2) Follow up appointment in 3-4 weeks
3) Get new blood work in 3-4 weeks to measure serum albumin and total protein levels
4) Follow up phone call in 2-3 days
Kerry Linne
3/16/17
N302L Case Studies
Nutrition Care Process (NCP): Calcium
 Age, Gender: 67, Male

 Knowledge, readiness for change: Came to local health fair, concerned about general
health
o BMI: 25.5 kg/m2 (overweight)
o IBW: 154 lbs/70 kg
 5’= 106#, 8” x 6#= 48#, 106+48= 154 lbs
 166#/154#=1.08 x 100= 107.8% (ideal)
 Total Energy= 1764.6-2156.8 kcal/d

by 1.3 then plus or minus 10%
 Protein= 60.4-75.5 g/d
o Used non-stressed state of 0.8-1.0 g PRO/kg
 Fluid= 1.8-2.2 L/d
o Used 1 ml per kcal
 Triglycerides: 89 mg/dl (normal)

 Serum albumin= 3.8 g/dl (normal)
 Glucose: 112 mg/dl (high)
 Cholesterol: 188 mg/dl (normal)
 Serum calcium: 9.8 mg/dl (normal)
 Urinary calcium: 300 mg over 24 hour period (high)
 Imbalance of nutrients R/T high sugar and high protein diet AEB high urinary
calcium (300 mg), glucose (112 mg) and BMI (25.5)

o Breakfast- 2 egg omelet with spinach, broccoli, mushrooms, and peppers
o Lunch- Spinach salad with grilled salmon
o Dinner- Baked potato, roasted vegetables, and tofu
o Snacks- almonds and sardines with bones and crackers
o Take calcium supplements if food is not sufficient
Goals
1) Decrease body weight by 1-2 lbs/wk until IBW is reached or BMI is normal
2) Reduce protein intake to DRI recommended levels
3) Normalize urinary calcium levels within 2-3 weeks
4) Consume sufficient amounts of fluid to prevent dehydration given high volume of
urination

1) Follow-up phone call within 1 week
2) Keep dietary food log for at least 3 days
3) Assess calcium intake and reduced protein levels
4) Reassess urinary calcium within 2-3 weeks
Kerry Linne
3/7/17
N302L Case Studies
Nutrition Care Process (NCP): Cholesterol
 Age, Gender: 39, male

 Food preferences, allergies, intolerances: fast-food restaurants, cereal, whole milk
 Knowledge, readiness for change: yes, weight loss clinic
o BMI: 32.5 kg/m2 (obese)
o IBW= 184 lbs/ 83.6 kg
 5’= 106#, 13” x 6#= 78#, 106+78= 184 lbs
 245#/184#= 1.33 x 100= 133.2 % (obese)
o Adjusted body weight: 199.3 lbs/ 90.6 kg
 (245#-184#) x.25 + 184= 199.3 lbs
 Total Energy= 2,718-3171 kcal/d

o 30-35 kcal/kg
 Protein= 72.5-90.6 g/d
o Used non-stressed state for 0.8-1.0 g PRO/kg
 Fluid= 2.72-3.2 L/d

 Glucose: 93 mg/dl (normal)
 Triglyceride: 123 mg/dl (normal)
 Hgb: 15.2 g/dl (normal)
 Hct: 43% (normal)
 Total cholesterol: 240 mg/dl (high)
Obesity R/T excessive fat and energy intake and physical inactivity AEB high total cholesterol (240
mg/dl), %IBW (133.2), and BMI (32.5).

o Breakfast- Whole wheat toast with avocado, non-fat yogurt, fresh berries
o Lunch- spinach salad with grilled chicken, tomatoes, peppers, and almonds
o Dinner- Baked potato, roasted vegetables, grilled salmon
o Snacks- fruit, vegetables, hummus, low-fat smoothie
o Refer to exercise physiologist for appropriate exercise routine
o Nutrition education
Goals
2) Normalize triglyceride values within 3-4 months
3) Begin regular exercise routine within 1-2 weeks
4) Lower kcal consumption within 1 week to recommended levels

1) Follow up phone call within 1 week
3) Get new blood work in 3-4 months to assess cholesterol levels
4) Check in weekly to see how exercise routine is going
Kerry Linne
3/2/17
N302L Case Studies
Nutrition Care Process (NCP): Diet lab

 Exercise habits: moderate exercise (weight lifting)
 Resources for obtaining, preparing food: farmers markets, home cooked meals
o Ht/wt: 71 in/ 180.3 cm and 205 lbs/ 93 kg
o IBW= 172 lbs/ 78.2 kg
 5’=106#, 11’ x 6#= 66#, 106+66= 172 lbs
 205#/172#=1.19x100= 119 % (overweight)

level (1.3) then plus or minus 10%
 Protein= 74.4-93 g/d
o Used non stressed state: 0.8-1.0 g PRO/kg
 Fluid= 3.3 L/d
o Used 35 ml/kg/day
Inadequate fiber, Vitamin A, and Calcium intake R/T low energy consumption AEB 24-hour food
recall and nutrient analysis fiber (58%), Vitamin A (40%), Calcium (58%), and total energy (49.6%)
of DRIs.

o Breakfast- Whole wheat toast with avocado, non-fat yogurt, fresh fruit
o Lunch- Brown rice, roasted vegetables, grilled salmon
o Dinner- Baked potato, side salad, roasted chicken, non-fat cottage cheese
o Snacks- almonds, rice cake, protein shake
Goals
2) Increase fiber, Calcium, and Vitamin A consumption to recommended levels
3) Increase total energy intake to recommended levels

1) Follow-up phone call within a week
2) Weigh food and record it in log
3) Record a 3-day food log
4) Revisit the lab in 2 weeks
Table 1. Nutrient Intake Data for 24-hr Recall

Energy CHO Fiber Fat Sat. Fat Pro Vit.A Vit.D Vit.C Iron Ca Sodium
(Kcal) (g) (g) (%Kcal) (%Kcal) (g) (ug) (ug) (mg) (mg) (mg) (mg)
Target 2600 130 38 25-35 <10 52 900 15 75 11 1300 <2300
Average 1289 166 22 21 3 93 359 30 401 8 760 1600

eaten
% DRI 49.6% 128% 58% 84% 30% 179% 40% 200% 535% 73% 58% 70%
Intake Low High Low Adequate Low High Low High High Adequate Low Adequate
Status
Kerry Linne
2/14/17
N302L Case Studies
Nutrition Care Process (NCP): Blood Glucose
 Diagnosis: Type 1 Diabetes mellitus

 Nutrition- related PMH, treatments, surgeries: None known
 Food preferences, allergies, intolerances: None known
 Exercise habits: basketball occasionally
 Knowledge, readiness for change: Unknown
 Functional/behavioral factors: Unknown
 Symptoms: Frequent urination, excessive thirst, hunger
o Ht/wt: 70 in/ 177.8 cm and 165 lbs/ 75 kg
o BMI: 23.9 kg/m2 (normal)
o IBW= 166 lbs/ 75.5 kg (no malnutrition)
 5’=106#, 10”x6#=60#, 106#+60#= 166#
 165#/166#= .993 x 100= 99.3% (no malnutrition)
o % Weight loss= 1.33% (no degree of malnutrition)

(1.3) then plus or minus 10%
 Protein= 60-75 g/d
o Used non stressed state: 0.8-1.0 g PRO/kg
 Fluid= 2.6-3.0 L/d
o Used 35 ml/kg/day
 Glycosylated hemoglobin= 9.4% (high)

 Serum albumin= 4.3 g/dL (normal)
 Serum Glucose: 180 mg/dL (fasting)
Medications/supplements:
 Inadequate adherence to nutrition-related recommendations R/T consumption of

poor diet: high fat, sugar, sodium, and lack of fiber. Evidence by fasting blood
glucose (180mg/dL) and HbA (9.4%). Inadequate exercise and lack of blood glucose
monitoring.

o Breakfast- Oatmeal with fresh fruit and glass of milk
o Lunch- Grilled chicken sandwich, salad, water
o Dinner- Grilled steak, baked potato, roasted vegetables
o Snacks- raw almonds, fat free yogurt, butter free popcorn
o Provide nutrition education for diabetics
o Exercise recommendations: refer to exercise physiologist
Goals
1) Monitor blood glucose twice per day
2) Exercise three times per week
3) Lower blood glucose and Glycosylated hemoglobin to normal levels
1) Follow-up phone call in 2-3 days
2) Ask patient to keep a food log
3) Follow-up appointment in 3-4 weeks to re-asses blood work for serum glucose and HbA
Kerry Linne
3/14/17
N302L Case Studies
Nutrition Care Process (NCP): HDL
 Diagnosis: Cardiac muscle damage

 Nutrition- related PMH, treatments, surgeries: Coronary artery bypass graft
 Age, Gender: 54, Female
 Symptoms: Recovering from surgery, smokes 2 packs/day, family history of heart
disease
o IBW: 120 lbs/54.5 kg
 5’= 100#, 4” x 5#= 20#, 100+20= 120 lbs
 148#/120#=1.2 x 100= 123.3 % (obese)
o Adjusted body weight: 127 lbs/ 57.7 kg
o (148#-120#) x .25 + 120#= 127 lbs
Energy, protein and fluid needs based on Adjusted Body Weight

o Used Mifflin-St. Jeor formula to determine REE then multiply by activity
factor 1.3 and injury factor 1.05-1.3 (postoperative)
 Protein= 72.1- 86.6 g/d
o Used major surgery state for 1.25-1.5 g PRO/kg
 Fluid= 1.6-2.0 L/d
o Used 1 ml/kcal/day
 AST: 76 U/L (high)

 ALT: 31 U/L (normal)
 LDH: 322 U/L (high)
 CPK: 268 U/L (high)
 Bilirubin total: 0.5 mg/dl (normal)
 Bilirubin direct: 0.1 mg/dl (normal
 HDL: 34 mg/dl (low)
 LDL: 156 mg/dl (high)
 Total Cholesterol: 240 mg/dl (high)
 Triglycerides: 250 mg/dl (high)
High fat diet R/T smoking, family history, and coronary artery bypass graft surgery AEB high
cholesterol (240 mg/dl), triglyceride (250 mg/dl), IBW% (123.3), AST (76 U/L), LDH (322 U/L), and
CPK (268 U/L)

o Breakfast- Whole wheat toast with avocado and assorted fruit
o Lunch- Quinoa, roasted vegetables, and grilled shrimp salad
o Dinner- Baked sweet potato, grilled squash, and grilled chicken
o Snacks- Almonds, rice cakes with peanut butter, protein shake
o Engage in cessation of smoking
Goals
2) Begin eating a healthy diet immediately
3) Quit smoking/reduce within 1 month

3) Get new blood work in 3-4 months to assess cholesterol, triglycerides, LDL, AST, LDH, and
CPK levels
5) Check in weekly to see how cessation of smoking is going
Kerry Linne
2/12/17
N302L Case Studies
Nutrition Care Process (NCP): Hemoglobin/Hematocrit
 Diagnosis: Unknown
 Nutrition- related PMH, treatments, surgeries: Unknown
 Food preferences, allergies, intolerances: Vegetarian
 Exercise habits: None known
 Knowledge, readiness for change: Fatigued
 Functional/behavior behavior: Breastfeeding and stopped taking vitamins
 Symptoms: worn out/weakness
o BMI: 18.6 kg/m2 (normal)
o IBW= 120 lbs (mild malnutrition)
 5’=100#, 4”x 5#= 20#, 100+20= 120 lbs
 108#/120#= .9 x 100= 90% (mild malnutrition)
o % Weight loss= 10% (mild degree of malnutrition)
 Total Energy= 2607.1 kcal/d

by 1.3 plus 500 kcals for lactation
 Protein= 51.3-61.1 g/d
o Used non-stressed state for .8-1.0g PRO/kg plus 12g for lactation
 Fluid= 2.6 L/d
 Hgb: 9.5 g/dL (low)

 Hct: 30% (low)
Medications/supplements: Prescribed but patient stopped taking them

 Inadequate energy and iron intake R/T lactation, vegetarian diet, and stopped
taking dietary supplements, AEB low value of Hgb 9.5 g/d, low value of Hct 30%,
and low IBW% of 90%

o Breakfast- Vegetable egg frittata
o Lunch- Cold quinoa salad with broccoli, kale, sweet peppers, and legumes
o Dinner- Baked sweet potato, roasted vegetables, grilled tofu
o Snacks- almonds, vegetables and hummus, vegan protein shake
o Consume multi-vitamin and mineral supplementation as prescribed
Goals
1) Increase caloric intake to more than 95% of the total energy recommended
2) Weight gain of 1 pound per week until reaching IBW
3) Normalize Hgb and Hct values within 3 months
4) Eat more iron rich plant sources
1) Follow up phone call in 3-7 days
3) Get new blood work in 3-4 weeks to reassess Hgb and Hct values
4) See if patient is still breast-feeding at follow up appointment
Kerry Linne
2/23/17
N302L Case Studies
Nutrition Care Process (NCP): Triglyceride
 Diagnosis: Type 2 diabetes mellitus

o Ht/wt: 61 in/154.94 cm and 152 lbs/ 68.946 kg
o IBW= 105 lbs/ 47.7 kg
 5’=100#, 1”x 5#=5#, 100+5= 105lbs
 152#/105#= 1.44 x 100= 144.8 % (obese)
o Adjusted body weight: 116.78lbs/ 53.1 kg
 (152#-105#) x.25+105=116.8 lbs
 Total Energy= 1593-1859 kcal/d

o 30-35 kcal/kg
 Protein= 42.5-53.1 g/d
o Used non-stressed state for .8-1.0g PRO/kg
 Fluid= 1.6-1.9 L/d
o Used 1ml per kcal

 Glucose: 145 mg/dl (high)
 Triglyceride: 250 mg/dl (high)
 Overweight status R/T preference high fat diet, AEB high blood glucose (145
mg/dl), high triglycerides (250 mg/dl), BMI 28.8 kg/m2, and %IBW 144.8%.
o Breakfast- Whole wheat toast with avocado, non-fat yogurt, fresh berries
o Lunch- Caesar salad with grilled salmon
o Dinner- Baked potato, grilled vegetables, and roasted chicken
o Snacks- Rice cakes, almonds, avoid chips, candy, soda
o Refer to diabetes educator for blood monitoring
Goals
2) Normalize glucose and triglyceride values within 3-4 months
4) Lower kcal consumption within 1 week to recommended levels

3) Get new blood work in 3-4 months to assess blood glucose and triglyceride levels

NCP Notes

Загружено:

Сведения о документе

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

NCP Notes

Загружено:

Авторское право:

Доступные форматы

Kerry Linne

 Diagnosis: Bladder cancer

Energy, protein and fluid needs

 Total Energy= 1998-2306 kcal/day

Labs/tests- can indicate high or low, normal or abnormal

 Total PRO= 5.5 g/dL, low (<6.0g/dL)

 Inadequate protein intake related to poor appetite and nausea/vomiting caused by

 Age, Gender: 67, Male

Energy, protein and fluid needs

 Total Energy= 1764.6-2156.8 kcal/d

Labs/tests- can indicate high or low, normal or abnormal

 Triglycerides: 89 mg/dl (normal)

 Meals and snacks

Nutrition Monitoring and Evaluation

 Age, Gender: 39, male

Energy, protein and fluid needs

 Total Energy= 2,718-3171 kcal/d

Labs/tests- can indicate high or low, normal or abnormal

 Serum albumin= 4.5 g/dl (normal)

Nutrition Diagnosis- PES format

 Meals and snacks

Nutrition Monitoring and Evaluation

 Age, Gender: 28, male

Energy, protein and fluid needs

 Total Energy= 2399.4-2932.6 kcal/d

Nutrition Diagnosis- PES format

 Meals and snacks

Nutrition Monitoring and Evaluation

Table 1. Nutrient Intake Data for 24-hr Recall

Target 2600 130 38 25-35 <10 52 900 15 75 11 1300 <2300

Average 1289 166 22 21 3 93 359 30 401 8 760 1600

 Diagnosis: Type 1 Diabetes mellitus

Energy, protein and fluid needs

 Total Energy= 2128.5-2601.5 kcal/d

Labs/tests- can indicate high or low, normal or abnormal

 Glycosylated hemoglobin= 9.4% (high)

 Inadequate adherence to nutrition-related recommendations R/T consumption of

 Meals and snacks

 Diagnosis: Cardiac muscle damage

 Total Energy= 1586.1-1963.8 kcal/d

Labs/tests- can indicate high or low, normal or abnormal

 AST: 76 U/L (high)

Nutrition Diagnosis- PES format

 Meals and snacks

Nutrition Monitoring and Evaluation

Energy, protein and fluid needs

 Total Energy= 2607.1 kcal/d

Labs/tests- can indicate high or low, normal or abnormal

 Hgb: 9.5 g/dL (low)

Medications/supplements: Prescribed but patient stopped taking them

 Meals and snacks

 Diagnosis: Type 2 diabetes mellitus

Energy, protein and fluid needs

 Total Energy= 1593-1859 kcal/d

Labs/tests- can indicate high or low, normal or abnormal

 Serum albumin= 4.2 g/dl (normal)

Nutrition Diagnosis- PES format

Nutrition Monitoring and Evaluation

Вам также может понравиться