Chapter 5 Nutrition Care Process ●

Weight (AD-1.1.2): 150 lbs (68.1 kg); JM has lost 2.8 pounds (1.27 kg).

● Body mass index (AD-1.1.5): 27.4 (overweight)

Biochemical Data, Medical Tests, and Procedures: ●

No new lab values available at this time.

Nutrition-Focused Physical Findings: ●

Overall appearance (specify) (PD-1.1.1): Well developed, well nourished, overweight, elderly female with a good appetite

Comparative Standards: ●

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Weight and growth recommendations (CS-5): IBW (CS-5.1.1): 110 +/– 10 lbs (50 +/– 5 kg) Recommended BMI (CS-5.1.2): 23

Energy needs (CS-1): Estimated energy needs (CS-1.1):

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Total energy estimated needs (CS-1.1.1): 1,478 kcal/d

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Method for estimating needs (CS-1.1.2): Using Mifflin-St Jeor’s calculations, current esti- mated RMR is 1,137 kcal; estimated TDE of 1,478 kcal is calculated as RMR × activity factor (1.3) × injury factor (1).

● Estimated protein needs (CS-2.2): ➤

Total protein estimated needs (CS-2.2.1): 50 to 69.4 g/d

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Method for estimating needs (CS-2.2.3): 1 g protein per kg IBW–1 g protein per kg ABW (13)

● Fluid needs (CS-3): ➤

Total fluid estimated needs (CS-3.1.1): 2,100 mL/d

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Method for estimating needs (CS-3.1.2): 30 mL/kg/d

Nutrition Diagnosis

Current nutrition diagnosis continues. JM’s nutritional status related to this diagnosis is improving.

Nutrition Intervention ●

● Interventions: ➤

Energy-modified diet (ND-1.2.2): 1,400 kcal/d meal plan. Goal: Energy intake for continued gradual weight loss.

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Composition of meals/snacks (ND-1.2): Three meals and two snacks. Goal: Plan a routine meal schedule.

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Schedule of food/fluids (ND-1.3): Fat-free dairy with meals; water and noncaloric beverages between meals. Goal: Consume

Nutrition prescription: 1,400 kcal/d meal plan, consisting of three meals and two snacks

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eight to nine (8-oz) beverages per day (2,100 mL/d) for adequate daily fluid intake.

Nutrition education—content (E-1.4): Nutri- tion relationship to health/disease: Discuss weight management. Goal: Obtain a healthier BMI of 23 and improve HbA1c.

Skill development (E-2.2): Discuss meal planning and food groups, portion control, and fluid needs. Goal: Understand portion control and food groups to aid in weight management/ healthier food/beverage choices.

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Nutrition counseling: Theoretical basis/ approach (C-1): Cognitive-behavioral theory (C-1.1): Establish goals for improved physical activity with client and family. Nutrition counseling: Strategies (C-2): Goal setting (C-2.2): Reduce TV time to 1 to 3 h/d and increase physical activity of choice (walk with daughter) to 30 min/d and 150 min/wk. Goal: Increase energy output and prevent further ight gain.

Monitoring and Evaluation ●

Total energy intake (FH-1.1.1.1): Criteria: Food diary: Three meals and two snacks per day with healthier snack choices

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Oral fluids (FH-1.2.1.1): Criteria: Food diary: eight to nine (8-oz) beverages per day for a total of 2,100 mL/d

Type of physical activity (FH-7.3.6): Criteria: Activity log: 30 min/d and 150 min/wk of activity of choice

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TV/screen time (FH-7.3.8): Criteria: Activity log: 1 to 3 hours TV/screen time per day

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Weight (AD-1.1.2): Criteria: Weight: Gradual decreased weight desired for a healthier BMI of 23

The nutrition diagnosis for this case study continues. JM has changed some of her eating style and her physi- cal activity level to improve the goals for her nutrition care. There is no new nutrition diagnosis. The nutrition interventions are in place to meet her goals. The moni- toring and evaluation indicators and criteria remain the same for the next nutrition counseling session.

CASE STUDY 2

Part 1: Initial Assessment AC is a 75-year-old married woman who was recently admitted to a skilled nursing facility (SNF) after multi- ple hospitalizations and stays at other long-term care (LTC) facilities for rehab. Her current medical