case study: dm/chd version 7
DESCRIPTION
Case Study: DM/CHD Version 7. Erica Frost, Katlyn Rhodes Samantha Mallik , Onalee Neff. Patient. Chad, 28 year old high school graduate Employed at a drug store Doesn’t eat fruit and vegetables, only meals with minimal preparation - PowerPoint PPT PresentationTRANSCRIPT
Case Study: DM/CHDVersion 7
Erica Frost, Katlyn RhodesSamantha Mallik, Onalee Neff
Chad, 28 year old high school graduate Employed at a drug store Doesn’t eat fruit and vegetables, only meals
with minimal preparation States abnormal thirst and hunger, and not
feeling right Admitted after found throwing up blood and
barely responsive
Patient
Breakfast:◦ 2 strawberry poptarts◦ 1 glazed doughnut◦ 1 cup lowfat milk
Snack:◦ 2 cups of coffee◦ 1 fruit danish
Dinner:◦ 1 frozen dinner, Hungry man Salisbury Steak◦ 12 oz Mountain Dew◦ 1 slice white bread◦ 1 tsp. butter
Snack:◦ 5 slices pepperoni pizza◦ 5, 12 oz light beers
Diet Assessment
24 hour recall◦ 13 medium fat meat exchanges◦ 1 low fat milk exchange◦ 22.5 starch exchanges◦ 30 fat exchanges
Kcals:◦ Carbohydrates: 1398◦ Protein: 666◦ Fat: 2183◦ Total: 4247
Diet Evaluation
Sex: Male Age: 28 Height: 5’10” (70 inches) Weight: 230 lbs (104.5 kg) Ideal body weight: 166 lbs % Ideal body weight: 139 BMI: between 33-34 Interpretation: Obese
Anthropometry
pH: 7.0 ◦ Indicates acidosis
HCO3: 19◦ Low
Interpretation:◦ Metabolic acidosis due to decrease in both pH and
HCO3
Acid/Base Balance
Diabetes*polydypsia and increased hunger- evident by patients subjective history. *Weight=139% IBW, 33-34 BMI, upon admission*Diet high in trans fatty acids, contributed more than 7% of his daily fat intake *Hyperglycemia- evident by
*Excessive alcohol consumption *Blood Glucose=560*Too much food *Nausea
*Diabetic Ketoacidosis (DKA)- evident by*Hyperglycemia*BP indicated Hypertension, which is a screening factor
for diabetes *Pt. HCO3 and PCO2 levels are low
Laboratory and physical data
Cardiovascular disease* Stage 1 hypertension- BP= 150/90*Poor diet-
*Pt. diet is high in Saturated and Trans fatty acids, more than 50% of his current dietary intake are from Fat*Alcohol consumption-
*more than 1-2 drinks a day increases BP* HDL lowers and Triglycerides raise
*Obesity- *BMI: 33-34 *related to hypertension*glucose intolerance
*Lab values-*Cholesterol: 325-elevated undesirable*LDL: 265-elevated*HDL: 40-borderline* elevated serum triglycerides
*Microalbuminuria-*marker of increased cardiovascular risk and hypertension
Laboratory and physical data
Primary◦ Excessive fat intake related to frequent
consumption of high risk lipids as evidenced by serum cholesterol level of 325 mg/dL, LDL of 265, and triglyceride of 300.
Secondary◦ Inappropriate intake of types of carbohydrates
related to cultural practices that affect the ability to regulate carbohydrates consumed evidenced by hyperglycemia and random blood glucose level of 560.
Nutrition Diagnosis
Angiotension II◦ Avapro
Reduces hypertension by restricting narrowing of blood vessels
Lovastatin◦ Lowers cholesterol by blocking the production of
cholesterol in the body◦ Reduces LDL and total cholesterol levels ◦ Lovastatin combined with a cholesterol lowering
diet plan is very effective
Medications
Caloric needs ◦ RMR= 10xwt(kg)+6.25xht(cm)-5x28+5
10x104.5+6.25x171.5-5x28+5RMR= 1982 Kcal *Ambulatory *BMR=1.3x1982=2577 Kcal *Adjusted BMR=1.5x2577= 3866 Kcal
* The Pt. calorie need is 2,577 Kcal
Metabolic Needs
Protein needs◦ Oral anabolic requirements
*Protein needs 1.2-1.5g/Kg*Kg actual body wt. 104.54x1.2=125
104.54x1.5=157 g Protein/day
◦ Grams of Nitrogen= 3866/150=25.7 g N required◦ 25.7N x 6.25=161 g Protein/day
*The Pt. protein need is125-161 g Protein/day
Metabolic Needs
Pt. IBW would be between 156-176lbs, this is a unrealistic short term goal, but could be a great long term goal for the patient to strive for
*We do recommend a 5-10% reduction of his current weight of 230lbs/104.54 kg
- with this reduction his weight would then be 207-218 lbs which is a realistic goal
* We do not recommend any weight loss until the Pt. is in a stable condition
Weight Loss Recommendation
The prescribed diet will consist of:◦ 55% of calories from carbohydrates◦ 20% of calories from protein◦ 25% of calories from fat
RMR= 2,577 kcal daily◦ 1417 kcal, 354 g carbohydrates◦ 515 kcal, 129 g protein◦ 644 kcal, 72 g fat
MNT Diet Prescription
Calorie Consumption:◦ The pt. is currently consuming 4247 kcal◦ Prescription: Reduce caloric intake to 2558 kcal
Fat Intake:◦ Current Intake: 242 kcal (150 g) ◦ Prescription: 70 kcal (35 g)
Protein Intake:◦ Current Intake:167 kcal (42 g) ◦ Prescription: 129 kcal (32 g)
Fruit and Vegetable Intake:◦ We recommend he adds fruits and vegetables to his diet.
Meat:◦ We are encouraging him to eat lean meat instead of medium meat.
Milk:◦ We are encouraging a higher milk consumption
Patients Intake vs. Prescription
Number of exchanges
Protein Carbohydrate
Fat
Meat 8 56 g -- 24 g
Milk 4 32 g 48 g --
Vegetable 4 8 g 20 g --
Starch 11 33 g 165 g 11 g
Fruit 8 -- 120 g
Fat 7 -- -- 35 g
TOTAL 42 129 g 353 g 70 g
Exchange Plan
Exchange Food
Breakfast 3 starch3 fruit2 milk1 fat
Lunch 3 meat2 starch2 fat1 vegetable1 fruit
Snack 3 fruit1 milk1 fat
Dinner 5 meat4 starch2 fat2 vegetable1 milk1 fruit
Snack 2 starch1 vegetable1 fat
11 starch exchanges : 11 g 8 meat exchanges : 24 g 7 fat exchanges : 35 g 4 milk exchanges (skim) : 0 g TOTAL : 70 g
Fat Calculations
5-10% weight reduction, short term goal Glucose maintained to desirable limit Achieve and maintain desirable lipid levels,
through diet and therapeutic lifestyle changes◦ LDL cholesterol < 130-159◦ HDL > 40◦ Triglycerides < 150-199◦ Cholesterol < 200-240◦ Blood Pressure 130-139/85-89
Patient Goals
Patient will regularly see RD, 4-8 times within 6 month period.
Set timeline with RD for setting goals, and visits
Record 3-day or weekly diet record for first visit showing understanding of prescription
Lab values will be taken to ensure BGL and lipid profile are effectively being reduced.
Implementation & Monitoring