Protein based on 1.0 g/kg BW

Transcription

1 INITIAL NUTRITION NOTE Age 84 years Gender Male Height (Feet) 5 ft Height (Inches) 11.0 in Patient Height 71 in Weight (pounds) 187 lbs Patient Weight 187 lb Body Mass Index 26.2 % Ideal Body Weight 172 lbs % Ideal Body Weight 108% Usual Body Weight 187 lbs % Usual Body Weight 100% Energy Needs kcal Kcalories based on 25-30kcal/kg BW Protein Needs 84.8 g Protein based on 1.0 g/kg BW Fluid Needs 2000mL Fluid Needs Specify: fluid restriction.

2 Medical Diagnosis: 84- year- old male admitted at the RSU for Rehabilitation. Patient has a recent acute hospital stay at BWH due to CHF. Past Medical History: CAD, HTN, AFib, Pulmonary HTN, Pericardial effussion, OSA, CKD stage 3, Anemia, Cirrhosis of the liver, Hypothyroidism, gout, BPH, thrombocytopenia. Pertinent Medication: vitamin D, lactulose, levthyroxine, iron, xifaxan, demadex Nutritional Lab Values: Na: 128, Cl- 97, BUN- 103, K- 5.1, Co2-20, Cr- 3.72, albumin- 2.5 Diet Order: No Added Salt Fluid Restriction: 2000 ml/day Food Allergies/Intolerances: No - Pt. dislikes oatmeal, hardboiled eggs Chewing Problems: No Swallowing Problems: No GI Problems: Yes - Pt. on lactulose. Diarrhea. Skin Issues: Yes - bruises, rash in groin area, excoriation around rectal opening Nutritional Assessment Summary 84 year old male admitted at the RSU for Rehabilitation. Patient has a recent acute hospital stay at BWH due to CHF. PMH includes: CAD, HTN, AFib, Pulmonary HTN, Pericardial

3 effussion, OSA, CKD satge 3, Anemia, Cirrhosis of the liver, Hypothyroidism, gout, BPH, thrombocytopenia. No food allergies, but dislikes oatmeal and hard boiled eggs. Current weight 187# indicates overweight. Aggressive weight loss not recommended at this time. Asked pt. about UBW, reports 187#. May be reporting his recollection from recent weight. Pt came into hospital at 207#, gained to 214# through fluid increase. Was diuresed to 199# at d/c. Continues on demadex, possible real wt loss? Pt. on NAS diet. Appropriate to continue at this time. Pt. amenable to try any diet to improve the way he feels. He reported finishing 75% of his meals. Pt. is recommended for fluid restriction, but reports he didn't follow it. Current FR in house is 2L/day. Pt.likes soups at RSU. Agreed to have soup 1x/d at lunch. Pertinent medications/supplements remarkable for vitamin D, lactulose, levthyroxine, iron, xifaxan, demadex. Pt. c/o diarrhea and declined last dose of lactulose on 2/5 b/o diarrhea. Pt. reports no N/V/C. Labs remarkable for Na, BUN, Cr 2/2 stage 3 CKD. Suggest keeping protein 1.0 g/kg (84.8g) 2/2 stage 3 CKD, but not too low 2/2 proper rash & bruise healing. Nutritional Dx Increased protein needs r/t proper bruise and rash healing AEB excoriation around rectal opening Decreased nutrient needs (sodium) r/t stage 3 CKD AEB increased Cr & BUN and decreased Na, edema in LEs 2+, and liver cirrhosis.

4 Inadequate fluid intake r/t stage 3 CKD and CHF AEB increased Cr & BUN and decreased Na, pt c/o dry mouth, skin dry in appearance. Nutrition Plan Intervention: Continue present diet Nutrition Recommendations - Continue NAS diet - Daily weight - Moderately increase protein intake - Monitor chem- 7 - Encouraged pt. to increase protein in meals - Encouraged increased fluid intake Monitoring & Evaluation Weight Intakes Labs Skin Nutrition Goals - continue consuming % of meals - Prevent dehydration - bruise and rash healing

5 - labs WNL - Euvolemia Elissa Goldman, Dietetic Intern Cosigned by: Kate Horrigan, RD, LDN