Drina Hartmann

NUFD 499
Dr. Dinour
2/19/17

Case Study B

Questions:

1. Convert the client’s height and weight to centimeters and kilograms. Calculate her %
IBW, % UBW, and BMI. Review her BMI and interpret her weight and weight changes
based on these parameters.

The client’s height of 59” to centimeters is 149.86 cm. The client’s weight of 95 lbs. to kilograms
is 43.18 kg. The client’s IBW is 100-5 lbs.= 95 lbs +/-10% (85.5-104.5 lbs.). The %IBW is equal
to 95/95 x 100= 100%. The client’s UBW is unknown, with verbal indication the client’s clothes
have felt looser. With the assumption her UBW is her upper limit of her IBW (104.5 lbs), her %
UBW would be equal to (95/104.5) x 100= 91%. With this information, her % weight change
would be equal to about 9%. Her BMI is equal to (43.18 kg/ 1.4986m2)= 19.2. With this BMI, her
classification would result at a health weight. Because she described her weight as decreasing
since her mother’s death (~2 months), I would interpret her current weight separately from her
UBW, which is indicative of being higher.

2. Access the Mini Nutritional Assessment-Short Form (MNA_SF) and complete the
screening for this client. What is the MNA score? Based on the MNA screening, what is
your recommendation for future intervention?

After completing the Mini Nutritional Assessment-Short Form1, the client’s score totaled to 6.
Under the screening score indicators, this would reflect malnutrition for the client. For future
interventions, I would recommend a referral for the client to several professionals. A therapist to
speak to about her recent losses may help relieve any emotional stress and provide closure to
the situation. Since this client may be eligible for SNAP, I would work with the client through the
process of applying which may help this client receive additional nutritional support.

3. Calculate her nutritional requirements (EER for calories and RDA or grams/kg for
protein). List her requirements for fluid and fiber, as well as the RDA for vitamins B12, D,
and A, and calcium.

EER= [(354-(6.91 x age)] + PA x [(9.36 x wt.) + (726 x ht.)]

EER= [(354-(6.91 x 65)] + 1 x [(9.36 x 43.18kg.) + (726 x 1.4986 m.)] = 1397 kcals/kg
2
Protein: 1.0-1.3 g/kg/day= 51.8 g/kg/day
Fluid: >6 glasses of fluids
Fiber: 21g/day
Vitamin B12: 2.4 mcg
Vitamin D: 600 IU
Vitamin A: 700 mcg RAE
Calcium: 1,200 mcg

4. Review her 24-hour dietary recall and calculate this day’s calories, protein,
carbohydrate, fat, fluid, fiber, and calcium levels. Are any food groups missing from her
diet on this day? If this day’s diet is typical, what nutrients might be low or missing from
it?

Before analyzing the client’s diet, by reading over the 24-hour recall, no dairy was reported. This
limits the client’s calcium and vitamin D intake as these nutrients are abundant in this food
group. Using SuperTracker to analyze this client’s nutrient levels, the calories were calculated at
just under 1400 kcals. Her nutrient intake included 65 g protein, 230 g carbohydrate (68%), 19 g
fiber, 491 mg calcium, and 32 oz of tea/fluids. Her total fat was listed as 15% of her caloric
intake, which is lower than her recommended 20-35% of kcals/day.

5. Are there any red flags in the patient and diet histories that lead you to believe there
might be a concern with her future nutritional health? Consider what is meant by her
comment concerning her own (“a bad wind made her cold”) and her mother’s (“bad
bones”) health status.

There are some indications that there may be problems in her future health from the patient’s
histories. Although her mother was reported to pass away from “bad bones,” her age of 85
years may have other implications of health that were not mentioned.3 The client feels they must
balance their intake by yin/yang methods in order for the body to become stable to feel better
again. Due to her beliefs, the client is assumed to be resistant to American forms of medicine,
relying only on OTC aspirin as medication. With the concerns that her appetite is decreasing
due to the loss of her mother and her cold/flu symptoms, her nutritional health may suffer as she
consumes around just enough calories for her daily living. When describing a problem to this
client, cultural considerations must be made over confusing the client with forms of medication
they are unfamiliar with.

6. Some of the foods consumed by this client might be unfamiliar to you. Describe the
following foods.
a. 4Pho- a soup with rice noodles, with beef or chicken broth, slices of meat, and
various vegetables.
b. Mung beans- in the legume family, a small round bean
c. Congee- similar to a porridge or gruel made of rice. Can be topped with ground
pork, bean sprouts, and mint
d. Nouc mam sauce- a vietnamese dressing made with fish sauce, vinegar, sugar,
water, lime juice, chopped chili and garlic.

7. What are yang foods and “hot” and “cold” foods?

In Vietnamese culture, people will categorize foods into “hot” or yang and “cold” 4or yin to
describe their balance on the body. “Hot” foods may lead to an excess amount of heat in the
body, causing inflammatory responses that lead to rashes and pimples. The “cold” foods are the
opposite, believed to lead to chilliness and multiple ill symptoms. These foods are eaten in a
pattern in order to balance the body between these types of foods.

8. List two each alternative “yin” and “yang” foods that might be incorporated into her diet to
help increase any nutritional deficiencies.

An example of a yin or “cold” foods would include melons as they are suitable for snacks for
potassium to balance her increased sodium intake through soups. Another yin food would be
yogurt, which could be eaten during breakfast. This would contribute to her dairy intake as well
as an easy food to consume. A “hot” or yang food that can be incorporated is seaweed into the
broth of her pho recipes, providing the umami flavor as well as fiber and calcium content. Along
with this food, salmon can be easily made and combined either in pho or served with a side of
rice. This would help provide omega-3 fatty acids and sufficient calories to avoid losing more
weight.

9. Write an appropriate nutrition diagnosis based on the available nutritional assessment

data.

One nutrition diagnosis for this client would be inadequate energy intake related to cold and flu
symptoms as evidenced by supertracker report of 1358 kcals with an EER of 1397, limited
access to nutrition related supplies, loss of appetite, limitation with balance of “hot” and “cold”
foods.

10. What are your nutritional goals for this client, based on her unique cultural background
and nutrition diagnosis?

For this client, I would set goals addressing her caloric intake and what she could do to obtain a
sustainable amount of calories. One goal may be to maintain or increase her weight by 2 lbs.
over the next 2 weeks in order to halt her unknown weight loss issue. I would work with the
client to develop additional recipes that incorporate yin/yang foods and work to identify other
food sources accessible to her. I would help set a small goal with the client to consume water
along with her meals in order to provide hydration, as tea can act as a diuretic.

Case Name: Case Study B #4

Step #1: Nutrition Assessment

Nutrition Assessment Case Example Indicators

Categories

N/A
Biochemical Data,
Medical Tests and
Procedures

Anthropometric Client is 4’11” (59”) tall (AD-1.1.1). Her weight (AD-1.1.2) is 95 lbs. (43.18
Measurements kg). Exact weight change (AD-1.1.4) is unknown; assumed between 5-10%,
described by clothes loosened since mother’s death (~2 mo.). Her BMI (AD-
1.1.5) is 19.1; classified as a healthy weight.

Nutrition-Focused Patient appeared of slight bone structure (PD-1.1.1). Patient has partial upper
Physical Findings dentures, normal oral health (PD-1.1.5). Visual acuity screen is WNL (PD-
1.1.6). Blood pressure is 120/80 mm Hg (PD-1.1.9).

Food/Nutrition- Food intake (FH1.2.2) includes vietnamese dishes (FH-1.2.2.2), meal pattern
Related History (FH-1.2.2.3) having similar lunch/dinner. Self-selected diet (FH-2.1.2.3)
yin/yang foods.
Eating environment (FH-2.1.3) eats at home (FH-2.1.3.1), eats alone (FH-
2.1.3.5). Medications (FH-3.1) include OTC aspirin (FH-3.1.2), ginseng and
ginger tea (FH-3.2.1).
Food/nutrition program participation (FH-6.1) may be eligible for SNAP (FH-
6.1.1)
Physical activity (FH-7.3) travels to corner store for food (FH-7.4.2).
Client History Personal History (CH-1.1): Client is 65 years of age (CH-1.1.1), female (CH-
1.1.2), Vietnamese ethnicity (CH-1.1.5), speaks limited English; Vietnamese
(CH-1.1.6), previous role of homemaker (CH-1.1.9).
Family/Medical History (CH-2.1): Father passed away from heart attack (CH-
2.1.2 F) 2 years ago, Mother passed from “many bad bones” (CH-2.1.14 F) 2
months ago. Client has not felt well, described as “a bad wind made her cold”
(CH-2.1.14 P).
Social History (CH-3.1): Dependent on SS and pension payments (CH-3.1.1),
currently living alone (CH-3.1.2), neighborly contact provide food support
(CH-3.1.4), recent deaths of mother and husband (CH-3.1.8).
Comparative Total estimated energy needs (CS-1.1.1) about 1400 kcals/day. (CS-5.1.1)
Standards IBW= 100-5= 95lbs. +/- 10% (85.5-104.5 lbs.). (CS-5.1.2) BMI= 19.2
(healthy).

Step #2: Nutrition Diagnosis

1. Problem Inadequate energy intake related to

Etiology cold and flu symptoms as evidenced by
Signs/Symptoms report of intake less than 1400 kcals, limited access to nutrition related supplies,
loss of appetite, limitation with balance of yin/yang foods, unintended weight loss.

Step #3: Nutrition Intervention

Nutrition Prescription (NP-1.1): (recommended dietary intake and dietary regimen)

Client should consume about 1500 kcals/day to maintain weight. Calories should include 45-65% of
carbohydrates, 10-35% of protein, 20-35% of fats. Recommended calcium intake of 1200 mg, 15 microg of
vitamin D, and 21 g of fiber.

1. Counsel client to develop an increased energy diet (ND-1.2.2.1) to promote weight

maintenance/gain
______________________________________________________________________________
Goal(s) Consume 1500 kcals/day to maintain or gain 2 lbs over 2 weeks.

2. _Referral to a psychologist (RC-1.5) to coordinate an outlet for her recent loss.

_________________________________________
______________________________________________________________________________
Goal(s) Identify a culturally appropriate therapist to analyze her mental health and any concerns regarding
her situation._____________________________________________
 3. _Modify composition of meals/snacks (ND-1.2) by including higher calorie food while balancing
for yin/yang foods. _______________________________________________
______________________________________________________________________________
Goal(s) Increase variety of meals by combining foods such as tofu, yogurt, eggplant, and banana.
_____________________________________________________________________________

Step #4: Nutrition Monitoring & Evaluation

When/time frame you plan to reassess: 1 week

1. Indicator Weight (AD-1.1.2)

Criteria Client will maintain or gain 1 lb. in 1 weeks time.

2. Indicator Total energy intake (FH-1.1.1.1)

Criteria Reported dietary intake will be greater than or equal to at least 1500 kcals/day

3. Indicator Accessibility to food services (FH-6.4.1)

Criteria Increased variety of vietnamese cuisine and yin/yang food balance.

4. Indicator Coordination with companion (FH-2.1.3.3)

Criteria Identify social issues and provide cultural care.
Bibliography

1. Inc AS. Nestlé nutrition institute - MNA® elderly - MNA® forms. http://www.mna-
elderly.com/mna_forms.html. Accessed February 19, 2017.
2. Nowson C, O’Connell S. Protein requirements and recommendations for older people: A
review. 2015;7(8). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555150/. Accessed
February 19, 2017.
3. CAO GIO (coin rubbing or Coining). http://healthpsych.psy.vanderbilt.edu/CAOGIO.htm.
Accessed February 19, 2017.
4. Guide C. Nutrition and Fasting in Vietnamese culture — EthnoMed.
https://ethnomed.org/clinical/nutrition/viet-food. Accessed February 19, 2017.