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Part I Introduction to Nutrition Care in Older Adults

diagnoses are urinary tract infection (UTI), hyponatre- mia, hypocalcemia, hypomagnesemia, anemia, ileos- tomy, and percutaneous endoscopic gastrostomy (PEG). She has a history of dehydration, poor appetite, hypertension (HTN), colitis, peritonitis, colectomy, small bowel resection, endometrial cancer, and gener- alized weakness, and she is unable to ambulate at this time. She experienced nausea and vomiting prior to her recent admission to the hospital. Her current medica- tions are pantoprazole (Protonix), warfarin (Coumadin), alprazolam (Xanax), multivitamin with minerals, diphenoxylate/atropine (Lomotil), metoprolol (Lopressor), and mirtazapine (Remeron). She received IV fluids and antibiotic therapy for the UTI, along with magnesium, calcium, potassium, and sodium to improve her electrolytes during her recent hospitaliza- tion. Her abdominal surgical wound is resolving with current treatments. Both heels are red and soft. She has a resolved wound area on her coccyx that is starting to redden but is not open at this time. No edema is reported. She does not smoke or drink alcohol. Most current hospital lab values are hemoglobin (Hb) 12 g/ dL; hematocrit (Hct) 34.5%; sodium (Na) 132 mmol/L; potassium (K) 3.8 mmol/L; glucose (glu) 87 mg/dL; blood urea nitrogen (BUN) 40; creatinine 0.63 mg/dL; calcium 8.9 mg/dL; and magnesium (Mg) 2 mg/dL. Her height is 63 in, and her admission weight is 145 lbs. She is alert and oriented, has upper and lower den- tures, has good hearing, and wears glasses. She is unable to stand or walk and uses a wheelchair to move about the facility. She currently receives a regular mechanical soft diet and an enteral 1.5 kcal/mL formula 1-can bolus five times per day with 60 mL water before and after each feeding. Medications are given orally. She feeds herself after tray setup by staff. AC was only consuming 0% to 25% per meal at the previous SNF and in the hospital. Currently staff reports that she is consuming 50% to 100% of her meals and often greater than 75%. During the RDN interview, AC stated that she wants to have her tube feeding decreased and eventually stopped. She enjoys her meals, the menu, and food service. She stated that her usual body weight (UBW) is 145 lbs and that she does not want to lose weight.

Nutrition Assessment Food/Nutrition-Related History:

● Food intake (FH-1.2.2): ➤

Types of food/meals (FH-1.2.2.2): Regular mechanical soft diet (standard diet offers 2,200 kcal, 92 g protein, and 900 mL water per day) plus 1,500 mL fluids on trays with extra water (greater than 1,400 mL/d) at bedside through- out the day

● ➤

Food intake (1.2.1): Amount of food (FH- 1.2.2.1): Oral intake reported: 50% to 100% of each meal

● Enteral nutrition intake (FH-1.3.1): ➤

Enteral nutrition formula/solution (FH-1.3.1.1): Enteral 1.5 kcal/mL formula in 1-can bolus five times per day (provides 1,775 kcal and 75.5 g protein per day)

●

Feeding tube flush (FH-1.3.1.2): 60 mL water before and after each feeding (provides 600 mL/d). Feeding plus flushes provides 1,500 mL fluid per day. Medications (FH-3.1): Prescription medication use (FH-3.1.1): Protonix, Coumadin, Xanax, multivitamin with minerals, Lomotil, Lopressor, and Remeron

●

Physical activity (FH-7.3): Physical activity history (FH- 7.3.1): She is unable to stand or walk and uses a wheelchair to move about the facility.

Anthropometric Measurement: ● ●

Height/length (AD-1.1.1): 63 in (160 cm)

Weight (AD-1.1.2): Admission weight is 145.2 lbs (66 kg); UBW 145 lbs (65.9 kg)

● BMI (AD-1.1.3): 25.8 (overweight)

Biochemical Data, Medical Tests, and Procedures: No new lab values are available upon admission to

SNF. Hospital values prior to SNF admission: ●

●

Nutritional anemia profile (BD-1.10): Hemoglobin (BD-1.10.1): Hb 12 g/dL Hematocrit (BD-1.10.2): Hct 34.5%

➤ ➤ ● Electrolyte and renal profile (BD-1.2): ➤ ➤ ➤ ➤ ➤ ➤

Sodium (BD-1.2.5): Na 132 mmol/L (low) Potassium (BD-1.2.7): K 3.8 mmol/L BUN (BD-1.2.1): BUN 40 (high)

Creatinine (BD-1.2.2): Creatinine 0.63 mg/dL Calcium, serum (BD-1.2.9): Calcium 8.9 mg/dL

Magnesium (BD-1.2.8): Magnesium (Mg) 2 mg/dL

Nutrition-Focused Physical Findings: ●

Overall appearance (specify) (PD-1.1.1): She is alert and oriented. She wants to keep her weight stable.

Head and eyes (specify) (PD-1.1.6): She has upper and lower dentures, good hearing, and wears glasses.

●

Digestive system (mouth to rectum) (specify) (PD-1.1.5): She has an ileostomy and a PEG tube.

Glucose/endocrine profile (BD-1.5): Glucose, fasting (BD-1.5.1): glu 87 mg/dL