ADIME Fall 2015

Erin Nyberg
-01259968
Nutrition Therapy: Auto-consult
Assessment:
Tina is a 19 year-old female with CF, diagnosed at 4 months. She is a freshman enrolled in
community college who has been studying and living a sedentary lifestyle. She was
admitted to the hospital after she became panicked and couldnt catch her breath. She
admits to feeling poorly for the last week and having a low-grade fever. She postponed
coming in because of an upcoming exam. The patient seems to have confusion about the
medications she is supposed to be taking. Her past medical history includes 4 sinus
surgeries to remove polyps, GERD, and a port placement and collapsed lung in 2009. Her
current medical history includes CF, MRSA in sputum of lungs, and pneumothorax. Tina
admits she is tired of always battling her disease.
Diet: CF
Dietary Intake:
Patient claims that her appetite has been poor for the last couple of weeks. She does not
eat meals at home with her family very often anymore. She has been forgetting to take
her multi-vitamin, also. She states she would like to learn how to eat better and take her
medications on her own. Her diet is poor and unbalanced with low fluid intake. A normal
days diet:
Breakfast: none
Lunch: cheeseburger (1oz cheese/3 oz burger)
French fries (small)
Whole milk (2 c)
Chocolate cake (2 oz)
Dinner: ramen noodles (1 c)
Celery with peanut butter
Milk (2 c)
Total intake: Approximately 1270 kcal/day
Height: 65 (1.65m)
Weight: 103# (46.8kg)
BMI: 17.2 - underweight
UBW: 115# (52.3kg)
%UBW: 103/115 = 90%
IBW: 125# (56.8kg)
%IBW: 103/125 = 82.4%
% Weight = (103-115)/115 = -10%
A weight of 103 pounds, at 19 years old, puts Tina under the 3 rd percentile.

Estimated Energy Needs: (using IBW)

Kcal: W.H.O.: [14.7(56.8kg) + 496] x (1.5 + 0.2) = 2263 x (1.2 steatorrhea) = 2716
kcal/day
Pro: 1.3-1.8 g/kg = 73.8 - 102.2 g/day
Carb: 45-65% = 1222 1765 kcal/day (306-441g/day)
Fat: 35-45% = 951 1222 kcal/day (106-136g/day)
Fluid: 2000-2400 ml/day
Labs reviewed:
FEV1 = 50% (moderate lung disease)
CFA = 78%
Nutrition Diagnosis (PES):
One sentence: Inadequate energy intake related to lack of knowledge about nutrition
relationship to disease as evidenced by 24 hour recall intake of 1270 kcals/day when TEE
is 2716 kcal/day.
Problem: Inadequate energy intake
Etiology: Lack of knowledge about nutrition relationship to disease
Signs and Symptoms: 24 hour recall intake of 1270 kcals/day when TEE is 2716 kcal/day

Nutrition Intervention:
1. Nutrition Education Content: Nutrition relationship to health/disease: Provide
patient with information about how and why CF increases her caloric needs.
2. Nutrition Education Content: Priority modifications: Discuss with patient ways to
increase caloric intake, i.e., calorically dense foods, 5-6 meals per day, and addition
of Scandishakes between meals. Have her begin keeping a food journal to record
her intake.
3. Coordination of Nutrition Care Collaboration and Referral of Nutrition Care
Referral to other providers: Suggest patient makes appointment with counselor who
can help her find ways to cope with living with a chronic disease.
Goal: By follow-up appointment, patient will have increased her daily intake by 1000
kcal/day.
Monitor/Evaluate:
1. Food and Nutrition Related History: Food and Nutrient Intake Total Energy Intake:
Use Tinas food journal to calculate estimated caloric intake.
2. Food and Nutrition Related History: Food and Beverage Intake Food Intake: Use
Tinas food journal to determine amounts of calories from all macronutrients to
insure that they fall within ranges appropriate for COPD.
3. Anthropometric Measurements: Body composition/growth/weight history Measure
Tinas height and weight to determine if weight loss/gain has occurred.