Nutrition Assessment 62 y/o BF; 155 lb (70.5 kg); 5 1 (152.4 cm); BMI 29 (overweight); IBW 105 lb, %IBW 148 (obese)

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1 Nutrition Assessment 62 y/o BF; 155 lb (70.5 kg); 5 1 (152.4 cm); BMI 29 (overweight); IBW 105 lb, %IBW 148 (obese) Requirements Energy: 1187 (REE-MSJ) x 1.2 (AF) = 1424 kcals = kcals/day Protein: g/day ( g/kg IBW) Fluid: L/day (1 ml/kcal) Labs: High: Alk phos, TG Dx: Diverticulosis with evidence of lower GI bleed in sigmoid colon resulting from episode of diverticulitis. Pt reports constipation for most of adult life with some recent episodes of diarrhea with crampy LLQ pain. Bright red blood present in stool (3 times in 24 hours); dry skin; NG aspirate heme negative upper GI source of bleed ruled out; colonoscopy negative for active bleeding, but numerous diverticula noted. Pt diagnosed with HTN 3 years ago. Tx: NPO; Pt hydrated with 50 cc/hr; metronidazole 1 g loading dose, then 500 mg every 6 hr; ciprofloxacin 400 mg every 12 hr; strict I/O Family Hx: Colon cancer (Father) Meds: Prinivil (limit alcohol); see Tx for additional meds. Food drug interactions included in counseling on discharge. 24 hour recall indicates intake of 1950 kcals (137% requirements), 13 g fiber (48% requirements), 3293 g sodium (143% recommendation), 86.3 g fat (150% recommendation; good appetite; pt enjoys cooking and baking especially with grandchildren and prepares her own food. Nutrition Diagnosis Excessive energy intake RT intake of high calorie foods like ice cream, pound cake, and potato chips AEB BMI of 29. Altered GI function RT low intake of fiber resulting from high intake of refined CHO and low intake of vegetables secondary to diverticulosis AEB intake of 13 g of fiber (48% of requirements), chronic constipation, and incidence of diferticulitis. Undesirable food choices RT lack of knowledge about healthy eating AEB intake of 3293 mg of sodium (143% of requirements) and 86 g of fat (150% of recommendation) and elevated triglycerides. Nutrition Intervention Educate patient on choosing lower calorie snacks. Goal: Decrease BMI to normal range. Counsel patient on benefits of consuming fiber and suggest high fiber foods, namely whole grains and vegetables. Goal: Reduce constipation and incidence of diverticulitis by increasing dietary fiber intake. Counsel pt on reducing fat and sodium intake.

2 Goal: Decrease fat and sodium intake. Lower triglycerides. Nutrition Monitoring and Evaluation Weight Fiber intake, constipation, incidence of diverticulitis 24 hour recall for sodium and fat intake; triglycerides

3 Counseling Outline Reason for Visit Diverticulosis with incidence of diverticulitis; to discuss high sodium and fat intake. Description of Disease (layman s terms) Diverticulosis is the presence of little pockets protruding from the large intestine caused by a life-long low fiber diet and constipation. When food gets stuck in these pockets, diverticulitis results, causing inflammation, pain, and sometimes bleeding. Dietary Modifications Required by Disease Diverticulosis requires a high fiber diet a diet rich in whole grains, fruits, and vegetables. During episodes diverticulitis, a low fiber diet is required until symptoms resolve. Since diverticulosis does not go away, one must continue a life-long high fiber diet except during episodes of diverticulitis. Positive Aspects of Current Diet Pt chooses moderately good portion sizes; pt trimmed fat from meat. Positive Reinforcement for Diet Behaviors that Do Not Need to be Changed Pt eats 3 meals. Pt enjoys cooking and purchases and prepares food herself. Pt does not consume alcohol. Candidly Review and Describe Nutrition Diagnoses or Problems Pt is overweight and consumes a low-fiber (low in whole grains and vegetables), high-calorie, and highsodium diet. Discuss the nutritional interventions and the goals of each intervention Pt needs education on diets for diverticulosis and diverticulitis. Diverticulitis requires a low fiber diet, including foods like refined grains (white rice and white bread), dairy, and lean meats. Upon recovery from diverticulitis episode, diverticulosis requires a life-long high fiber diet consisting of foods like whole grains (whole wheat bread, brown rice, oats) and vegetables like broccoli, cauliflower, celery, and carrots. Pt also needs education on decreasing sodium and fat intake. Goals: Set achievable goals with client to increase fiber intake upon recovery from diverticulitis episode, primarily from whole grains and vegetables. Set realistic weight loss goals to achieve a healthy BMI. Set achievable goals to decrease sodium and fat intake. Explain how achievement of goals with be monitored Weight will be monitored for weight loss. Perform a 24 hour recall at follow-up to observe fiber and sodium intake. Discuss the need and the reasons for behavioral change, goal identification and goal importance After recovery from diverticulitis, a high fiber diet will decrease constipation and reduce the risk of another episode. Goals are important to observe achievements; it is crucial that goals are valued by pt to ensure adherence and success. Discuss and explain sample menu Two sample menus will be provided: one low fiber diet for diverticulitis and one high fiber diet for diverticulosis.

4 The diverticulitis diet contains low fiber foods like refined grains, dairy products, fruit juice, and meats. The diverticulosis diet contains high fiber foods like brown rice, whole wheat bread, broccoli, and carrots. Provide useful information, tips, electronic and other resources and handouts National Digestive Diseases Information Clearinghouse: digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/ MedlinePlus:

5 Sample Calorie Menu Diverticulosis (High Fiber) Breakfast 1 slice whole wheat toast 1 tsp margarine 1 banana 6 oz coffee, decaffeinated 8 oz 1% milk Lunch ½ cup vegetable soup 2 slices whole wheat toast (grilled cheese sandwich) 1 slice American cheese, low fat, low sodium (grilled cheese sandwich) 1 apple 16 oz water Dinner 2 oz roast beef ¾ cup brown rice ¼ cup gravy ¾ cup broccoli, cooked ¾ cup carrots, cooked 12 oz 1% milk Snack eat when desired 8-4 strips of celery 2 tbsp low sodium peanut butter 8 oz water Total Energy: 1481 calories % CHO: 53% % Protein: 18% % Fat: 29% Fiber: 28 g Sodium: 2274 mg

6 Sample Calorie Diet Diverticulitis (Low Fiber) Breakfast 1 scrambled egg 1 slice white toast 8 oz orange juice Lunch 1 cup low sodium chicken noodle soup 8 low sodium crackers ½ cup grapes 1 cup romaine lettuce ¼ cup cucumbers ¼ cup tomatoes 2 tbsp low calorie ranch dressing Dinner ½ cup angel hair pasta 1 cup tomato sauce with ground turkey ½ cup green beans 8 oz skim milk Snack eat when desired Yogurt Total Energy: 1403 calories % CHO: 59% % Protein: 17% % Fat: 24% Fiber: 15 g Sodium: 2014 mg