Nutrition Care

Conference
Esha Fletcher
UConn Health Center
Fall 2015

Patient
Age: 68
Gender: Female
BMI: 25.4 (overweight)
Height 54 or 64 inches
Weight: 148.5# or 67.5kg
UBW: 152# or 69kg
IBW: 120# or 54.5kg
Date Seen: 11/4 & 11/5

Admitting Diagnosis
Sigmoid Diverticulitis
Inflammation of the pouches in the mucosal
layer of the colon. The sigmoid is the part of
the colon that connects the descending colon
to the rectum

MNT for Diverticulitis

Patient temporarily on low fiber, clear liquid
diet until problem resolves
Once the acute phase heals, patient should
start adding fiber slowly back to their diet
(could cause bloating or gas)
Adequate fluid intake (2-3L/day)
High fiber diet: 25g/day for women, 38g/day
for men
New research shows there is no need to avoid
nuts, popcorn or seeds unless they irritate
that particular pt

Assessment
Past Medical History
HTN, Breast Cancer, GERD
Social History
Patient lives at home with husband and she is
the main cook
Nutrition History
Patient cooks a lot of soups and homemade
meals. She admits to adding salt to her foods
and said she needed to work on that
She denied eating a lot of processed or fast

Nutritional
Requirements
Female:(9.99 x 67.)5 + (6.25 x 162.56) (4.92
x 68) +161
= 1,553 (1.3 activity factor)

Kcal/kg: 1,687

Range 1,500-1,700 kcals

Protein: 1.0-1.2g/kg, 68-81g/day

Fluid: 30cc/kg, 2,025ml

Diet Order
Sips of Clear Liquids
Easily digested and leaves no undigested
residue in the intestinal tract
Used before tests, procedures or surgeries that
require no food in the stomach or intestines
Ex: water, broth, plain gelatin, sports drinks,
honey, carbonated drinks

LABS
Lab Name

Current Lab Normal

Range

Notes

BUN

12

8-24

WNL

Creatinine

0.7

0.6-1.2

WNL

Glucose

77

75-100

WNL

Bicarb

22

22-29

WNL

Chloride

106

98-107

WNL

Sodium

139

137-144

WNL

Potassium

4.0

3.5-5.1

WNL

Hct

34

40-52

Low. Falsely low due to

overhydration

Hgb

13-18

Low. Falsely low due to

overhydration

Significant Meds
Medication

Notes

Colace
Docusate

Stool Softener. 1500-2000ml fluid/d to prevent

constipation. Side effects: cramps, diarrhea.
Caution with intestinal disorders

Lactated
Ringers

125ml/hr IVF given. Fluid and electrolyte

replenishment

Heparin

Anticoagulant. Side effects: N/V, abdominal

pain, GI bleeding, constipation. Osteoporosis,
bone & muscle pain, hair loss w/ long term
use >6 months

Zofran

Antiemetic. Side effects: dry mouth,

abdominal pain, constipation, diarrhea

Flagyl

Antibiotic. Side effect: N/V, dry mouth,

candidiasis, diarrhea, constipation

Pantoprazole

Antigerd. Side effects: decreased gastric acid

secretion, nausea, increased gastic pH,

Nutrition Diagnosis
Patient assessed with inadequate
protein-energy intake related to altered
GI function as evidenced by sigmoid
diverticulitis and diet order of only sips of
clear liquids

Intervention
Food and Nutrient Delivery
As inflammation resolves, patient should be
advanced to low residue diet
Nutrition Education
Educate patient on low sodium diet and foods
allowed on a low fiber diet
Patient was given handouts for each diet

Monitor & Evaluation

Coordination of Nutrition Care
Discuss with nurses and MD: improvement in
patients medical condition and tolerance of clear
liquids, then advancement of diet
MD to consider decreasing IVF as patients
requirements only 2,025cc, with +I/Os of 1130 cc
Food/Nutrition Related Outcomes
Once diet is advanced, monitor intake and tolerance
of low residue diet
Anthropometric Measurements
Monitor weight for maintenance and intake for diet
to be advanced to low residue

Monitor & Evaluation

Biochemical Data
Monitor electrolytes such as Mg, Phos and K,
looking out for refeeding syndrome
Monitor fluid balance
Nutrition Focused Physical Findings Outcomes
Monitor function of gut and patients appetite so
she can advance to a low residue diet
Nutrition Education Outcomes
Patient will be able to name 3 low fiber foods
Patient will be able to name 3 foods low in sodium

Meal

Amount

#
exchanges

CHO g

Pro g

Fat g

Breakfast

Calcium-fortified cereal

1 cup

2 starch

23

92

15.1

207

41.8

139

Canned pears

1 cup

2 fruits

30

120

9.8

4.9

129

17.1

Scrambled Eggs

1 egg

1 meat

102

43.3

171

84.2

104

Almond Milk

1 cup

1 fat

22

162

420

126

410

51

236

Water

236

Snack

Canned Peaches

1 cup

2 fruits

37

120

7.5

13

243

27.6

Water

8 oz

236

Lunch

Small dinner roll

1 oz

1 starch

15

80

28.1

136

39.9

38

Baked Fish

3 oz

3 meat

19

105

16.1

75

279

216

Cooked Spinach

1/2 cup

1 vegetable

41

245

126

839

101

Cranberry Juice

1 cup

2 fruit

31

116

20.2

195

32.9

236

Water

8 oz

236

Snack

Chocolate Pudding

1 cup

2 carb

25

153

55.1

164

199

66.5

Water

8 oz

236

Dinner

White rice

1 cup

2 starch

45

205

15.8

55.3

68

Baked Chicken

3 oz

3 meat

27

142

12.9

64

220

196

Cooked sliced carrots

1 cup

2 vegetable

11

54

51.1

86

280

45.3

Small dinner roll

1 oz

1 starch

15

80

28.1

136

39.9

38

Water

16 oz

472

Snack

Pineapple

1 cup

2 fruit

22

82

21.5

180

13.2

Water

8 oz

236

Totals

284

85

32

1654

989.6

1317.9

3235.1

1153.6

2124

Estimated Needs

1550

1200

<2000

1300 - 3000

800-1000

2,025

Calories Calcium (mg)

Sodium
(mg)

Potassium (mg) Phosphorus (mg)

Fluid
(ml)

References
http://nutritiondata.self.com/facts/fruits-and-fruit-juices/18
09/2
Mahan, L., Escott-Stump, S., Raymond, J. Krauses Food &
the Nutrition Care Process. 13ed. 2012
https://www.nutritioncaremanual.org/client_ed.cfm?ncm_cl
ient_ed_id=99
https://www.nutritioncaremanual.org/client_ed.cfm?ncm_cl
ient_ed_id=
3
http://www.mayoclinic.org/diseases-conditions/diverticulitis/
basics/definition/con20033495
http://www.mdguidelines.com/diverticulosis-and-diverticuliti
s-of-

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