ADIME Note: Case Study 3

ASSESSMENT

Food/Nutrition Food Recall​: (approx. 1900-2000 kcals)

Related Hx 4-5 milkshakes with CIB, whole milk, and several scoops of ice cream.
Juice
Whole milk
Water
2 yogurts
Mashed potatoes
Helen has started to only consume liquids in the past 2 weeks. She states that she
has a lump in her throat and it is hard to swallow. Helen enjoys cooking simple
foods for her family and watching cooking shows on TV.

Medications​: Singulair for allergies

Physical activity​: Less energy recently and lower activity level.
Anthropometric Ht: 1.3 cm
Measures Ht %ile: above 97​th​ percentile
WT: 35kg
Wt %ile: above 97​th​ percentile
BMI: 17.5
BMI%ile: 84​th​ percentile
MBW: 30.9 kg
MBW: 88%

Target weight​: at 75​th​ percentile is 33.4 kg

Weight loss​: 10 lb in 2 weeks (12.9% of body weight)
Caloric needs​: 70 kcals/kg = 2450 kcals.

Biochemical Lab work and CT scan were normal. Barium swallow was normal.
Orthostatic hypotension: 112/60 and pulse 60 when lying and 110/68 and 68
when standing.
NFPF No diminished gag reflex or uncoordinated swallow. There was Mild bruising on
shins. The patient was reluctant to answer some questions regarding her food
intake. The patient stated she has been feeling sad recently. She has some OCD
behaviors, such as biting nails and repeating sentences prior to uttering them.

Client Hx The patient lives with her mother, father and twin sister. Her sister enjoys wearing
pink and purple dresses and Helen enjoys wearing boy’s clothes. The patient has a
family history of anxiety and her mother is currently on Lexapro for mood. The
patient stated that she gets along with her father, but has trouble connecting with
her mother. Her mother has recently undergone back surgery and has been at
home recovering for the past 4 weeks.
DIAGNOSIS
Disordered eating pattern​ related to anxiety about swallowing as evidenced by diet recall, fatigue, lower activity level, and weight loss (10 lb in 2
wks).
INTERVENTION
1. Nutrition Prescription
● Meal plan: 24 item throughout the day as 3 meals and 1-3 snacks.
● Introduce 1 food exposure item each day.
2. Nutrition Education
● Education on meal plan format and food “items.”
3. Nutrition Counseling
● Use self-monitoring techniques by filling out meal plan for each meal.
● Motivational interviewing to determine patient-centered strategies for food exposure.
● Patient Goals:
o Complete food exposure chart by trying one new item each day.
o Consume 3 meals and 1-3 snacks a day.

4. Collaboration of Care
● Collaboration with patient’s therapists to design a food exposure chart with positive reinforcements for the patient.

MONITORING AND EVALUATION

1. Indicator
● Patient’s weight will have gains for growth.
● Food records and challenge chart.

2. Criteria
● Patient will consume 100% of meal plan and eat a challenge food daily.