Care Conference

Riverside Health and Rehabilitation Center

Katie Sprague

About the Patient:

Patient Initials: J.S.
75 years old
Gender: F
Admission Date: 10/21/08

Medical Diagnoses
Type II Diabetes
HTN
Breast cancer
Hyperlipidemia
R. knee MRSA
Class 1 obesity
Osteoporosis
Patellectomy

Type II Diabetes Definition

Insulin resistance and beta cell failure
Glucose builds up in the blood causing
hyperglycemia
Believed to have a strong genetic component
Related to weight and diet
Behavior modifications and lifestyle changes
pertaining to diet, exercise and insulin monitoring
are necessary

MNT for Type II Diabetes

Follow the DRIs for healthy eating
Monitoring carbohydrate intake and the glycemic index of certain
foods
Consuming 25-30g of fiber per day
Sucrose should be limited
Patient should consume more than 20% of their total calories as
protein
Fat intake:
foods high in omega 3 fatty acids

MRSA
Strain of Staphylococcus aureus that causes infections on different
parts of the skin
Can be mild: sores or boils on the skin
Can be more severe: infections on surgical wounds, enter the
bloodstream, infect the lungs and infect the urinary tract
It can be hard to treat and sometimes fatal
Spread by: human to human contact, contact with infected objects
Resistant to many antibiotics

MNT for MRSA

Probiotics
fermented products like cheese and yogurt
supplement
Vitamin C
citrus fruits, supplement
Vitamin E and C (antioxidants)
nuts, seeds, sweet potatoes or supplements

Physical Signs
Alert
Non ambulatory
Pink skin pigment
Warm skin temperature
Obese

Psychosocial Data
Divorced
1 son, visits frequently
White
No religion listed
Has both medicare and medicaid
A favorite activity: attending happy hour at Riverside, and enjoying
wine or beer with her son
Fun fact: she loves Italian food and misses being able to cook her
favorite cheesy baked spaghetti!

Nutrition History
Likes:

Dislikes:

All vegetables

Plain potatoes

apples, oranges and

watermelon

Rice

eggs
cheese
wheat bread
wine and beer

Milk
Heavy desserts
Foods high in sugar

Nutrition History
No known food intolerances or allergies
No physical feeding problems
Appetite: patient reported as good
Usual meal pattern: 3 full meals with NO snacks

Anthropometric Data and Clinical

Data

Weight: 161 lbs (73kg)

Height: 5 ft. (1.52m)

BMI: 31.6 - Class 1 obesity (Krause)
IBW: 100 lbs
IBW%: 161%
DBW: 150 lbs
%DBW: 107.3%

Clinical Data/Treatment and Therapies

Blood pressure: 142/62 - irregular
Temperature: 97.9
Rehab Therapy for power wheelchair
OT for osteoporosis and R and L hand splints

Medications
Furosemide
Metoprolol
Multivitamin tab
no major side effects!

Biochemical Data
BUN: 18 [7-17] high
Sodium: 133 [133-145] low
Chloride: 93 [98-107] low
HbA1C: 6.9 [<5.7] high
Normal levels for creatinine, potassium, HDL, LDL
and triglycerides
no values listed for FBG/BG, Hgb, Hct, RBC, WBC,

Diet Order
Diet order on 9/29/15: regular, whole with dessert
and sugar substitutes
Adjusted diet order as of 11/10/15: Patient
requested low concentrated sweets diet
The new diet order is appropriate

Nutrient Needs
Harris Benedict Equation using adjusted BW: 1086
Cal requirements: 1086 x 1.2 (activity factor) x 1 (injury factor) =
1303 kcals/day
CHO: 45% of daily calories = 586 kcals
586cals/4 = 146 gm

Protein: 25% of daily calories = 326 kcals

326cals/4 = 81gm OR 0.8x 73kg = 58 gm

Fat: 30% of daily calories = 391 kcals

390cals/9 = 43gm

Nutrients, Vitamins and Minerals

Protein intake low- 33g [46g]
Fiber intake low- 18g/day [25-30g/day]
Minerals: calcium, potassium, iron, magnesium,
phosphorus and zinc are all low
Vitamins: Vitamin B6, B12, C, D, E, K, folate,
riboflavin, niacin, and choline are all low

Sample Menu
Breakfast:
- cup unsweetened cereal with 1 cup non fat milk
- 1 small banana
- 2 scrambled eggs
- 8 oz. of water
Lunch:
- 3 oz. skinless chicken breast
- cup cooked green beans with 1 tsp. butter
- 2/3 cup quinoa

Sample Menu
Dinner:
- 3 oz. grilled salmon
- cup cooked spinach with 1 tsp butter
- cup cooked carrots with 1 tsp butter
- 1 whole wheat dinner roll
- 8 oz. of water

Drink 5-8 oz. of water upon waking up, in between meals and
in between dinner and bedtime

Nutrition Care Process

PES 1: Altered lab values as related to type II diabetes
mellitus as evidenced by a HbA1C reading of 6.9
[<5.7]
Intervention: Nutrition education and nutrition
relationship to health and disease
Monitoring/Evaluation: Monitor HgA1C and FBG lab
values

Nutrition Care Process

PES 2: Obese class I due to physical inactivity as
evidenced by confinement to a motorized wheelchair.
Intervention: Nutrition education and nutrition
relationship to health and disease.
Monitoring/evaluation: Monitor weight

References
Krause (definition and MNT of DM)
WebMD (definition and MNT of DM)
MayoClinic (definition and MNT for MRSA)
eNCPT (PES, intervention and monitoring/eval)

Questions?? :)