CARE

CONFERENCE
FALL 2017

Kayla McCabe
ASSESSMENT
Patient: LF
• 90 y/o, Female
• Admitted: 11/14 • Chief Complaint
• Seen: 11/15
– SOB reported following vomiting episode
• Admitting Dx:
– Aspiration Pneumonia
– Presence of unstageable pressure ulcers to L & R heels
– Mid-oral dysphagia
• PMHx:
– Severe dementia, DM2, HTN, CHF, Bladder Cancer (in her
20’s), GI Bleed, Pelvic Fracture (1 year prior)

Ht: 5’6” Wt: 121 lbs. IBW: 130 lb. %IBW: 93% BMI: 19.38, Normal
 • Severe dementia- limited communication abilities
Physical • Difficulty chewing and dry mouth

Findings • Large appetite (had been NPO for 2 days)

• No evidence of fat or muscle wasting
• Unstageable pressure ulcers on both heels

Social • Lives at SNF due to severe dementia

History • 4 adult children

Diet • Regular diet at SNF

• NPO x 2 upon admission due to aspiration episode
History • Advanced to: Mech Soft, 250 gm CHO | 1800 kcal ADA
Lab Results
Name Normal Range Patient’s Value Date
Phosphorus 2.5-4.5 mg/dL 3.5 11/15
132 L 102 20
143
Magnesium 1.8-3.6 mg/dL 1.7 L 11/15
4.5 25 .6

A1C < 7.0% 5.7 5/16

Blood Sugar (Finger Sticks) 75-180 mg/dL 125, 143, 162, 134 11/14-11/15
Medications
Name Dose Purpose
Aricept Donepezil HCl 10 mg PO /day Treats vascular and mixed dementia

Metoprolol 25 mg PO / day CHF treatment

Lovenox 40 mg SQ / day Anticoagulant

 Energy • Mifflin x 1.2 + 250 (for wound healing)

Requirements – 1,442 kcal

– 26 kcal/kg

• Protein: 1-1.2 gm/kg

– 55-66 gm protein

• Fluid: 1 mL/kcal
– 1,442 kcal/day
DIAGNOSIS
Diagnosis
Increased protein needs related to wound healing as
evidenced by unstageable pressure ulcers on both left and
right heels.
INTERVENTION
Intervention • 1500 kcal, 210 gm CCHO ADA diet

• 4 oz. of Glucerna 2x/day

• Mechanical Soft Diet

• Coordination with SNF

• Education to family

• MVI with minerals

 MONITORING
& EVALUATION
M&E
• Wound healing!
• Intake > 75% of meals and supplements
• Adequate hydration (at least 1 kcal/mL)
• Maintain weight
• Mg++ & Na+ labs for changes
• Redo swallow evaluation when LF returns to SNF
• New A1c
MEAL PLAN
Supplements: Dinner:
Food Item KCal CHO (gm) Protein (gm) Fat (gm) Fluid (mL) Food Item Kcal CHO (gm) Protein (gm) Fat (gm) Fluid (mL)
8 oz Glucerna* 220 26 10 9 237 2 oz spaghetti 200 42 7 1 0
2 beef meatballs 114 4 6 8 0
Breakfast: 1 cup marinara sauce 70 10 2 2 0
1 cup steamed mixed
Food Item KCal CHO (gm) Protein (gm) Fat (gm) Fluid (mL)
veggies 45 10 2 0 0
2 Scrambled Eggs 203 3 14 15 0
Totals: 429 66 17 11 0
1/2 cup Fruit Cocktail 100 25 0 0 120
4 oz Lite Blueberry
Yogurt 60 11 4 0 0
1 medium pancake 74 14 2 1 0
1 oz. sugar free syrup 8 3 0 0 29
Totals: 445 56 20 16 149 Totals:
Kcal CHO Protein Fat Fluid
Lunch: 1455 200 66 45 678**
55% 18% 28%
Food Item KCal CHO (gm) Protein (gm) Fat (gm) Fluid (mL)
1 c creamy tomato
soup 123 22 8 1 232
1/2 grilled cheese 174 16 9 7 0
1/2 cup steamed, soft
broccoli 24 5 2 0 0
1/2 cup canned
peaches (in juice) 40 9 0 1 60
Totals: 361 52 19 9 292

** LF should be encouraged to drink 3.5 cups of water or sugar free juice

each day to meet her fluid needs.
QUESTIONS?
References
Jackson CE, Meier DW. Routine serum magnesium analysis. Correlation with clinical state in 5,100
patients. Ann Intern Med1968;69:743-748.

Pronsky, Zaneta M. Food-medication interactions. 18th ed. Birchrunville, PA, Food-Medication

Interactions, 2015

Mahan, L. Kathleen., Escott-Stump, Sylvia., Raymond, Janice L.Krause, Marie V., eds. Krause's
Food & The Nutrition Care Process. St. Louis, Mo. : Elsevier/Saunders, 2016. Print.

American Dietetic Association. Nutrition Care Manual®. http://www.nutritioncaremanual.org. Accessed

[3/8/2017].