MEDICAL NUTRITION THERAPY

Lesson 5 Case Study

Determine Basic Concepts of Medical Nutrition Therapy
Angela Martin
United States University

MEDICAL NUTRITION THERAPY

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Case Study

1. How old is Frank?

Since Frank was born in 1919, so he is ninety-three years old as of 2012.
2. What is Frank's percentage of ideal body weight?
The idea of percentage of ideal body weight depends on various factors. First of all we
calculate patients ideal weight as a function of their age, gender and height. Then we see the
percentage of their weight and ideal weight.
Percentage of Ideal Body Weight = Original Weight/ Ideal Weight * 100
Percentage of Ideal Body Weight = 133 lbs / 147lb *100
Percentage of Ideal Body Weight = 93.75%
3. What does Frank's lab report tell you about his iron status?
The problem of anaemia is the most intractable and common nutritional problems today.
The main reasons of anaemia are: inherited conditions (thalassaemia), deficiencies of key
micronutrients (Vitamin A, Vitamin B12 and flotae), schistosomiasis and hookworm infections,
malaria and most importantly dietary iron deficiency (Pinkney, Johnson & Gale, 2010). The
dietary iron deficiency is measured by evaluating patients iron status. Franks iron status can be
evaluated by his HCT and HGB stats. Frank seems to have mild anemia as his Hgb is 9 g/dL. On
the other hand, Franks hermatocrit of 22 % means that there are 22 milliliters of red blood cells
in 100 milliliters of blood. Franks hematocrit is low because the hermatocrit of adult males
should be between 42% to 54%.
4. What does Frank's lab report tell you about his protein status?
Protein status in any patient is evaluated by visceral and somatic protein status. visceral
protein status involves measurement of all other proteins (white blood cells, blood cells, serum,
viscera and organs) and somatic protein status involves measurement of the protein in skeletal
muscle. Two important indicators of protein status are prealbumin (PAB) and serum albumin
(Alb). If the albumin levels in patient are low, then its considered as a warning sign an

MEDICAL NUTRITION THERAPY

indication of liver disease. Other liver enzyme tests are ordered to determine exactly which type
of liver disease. On the other hand, high albumin levels mean that the patient is dehydrated.
The normal PAB range is 15 to 36mg/dL, so Franks thyroxine-binding prealbumin is just at
border. On the other hand, Franks Alb value of 3.1indicate severed protein depletion as its
between 0 to 5 mg/dL.
5. Frank has been at Beets Nursing Center for 1 month. He has eaten <25% of all his meals.
He says the food is tasteless. He has lost 10 lbs. His diet is 2 gm Na, low fat low cholesterol,
mechanical soft. Do you think Frank's diet is appropriate? Explain your answer. Discuss
each dietary restriction and support your answer with information from his medical
profile.
Franks diet is appropriate because he has very high cholesterol level around 275 mgldl
which can be due to consumption of foods having elevated amount of saturated fats (food
seasoned with fat and salt). Other reasons due to which Frank has high cholesterol can be
excessive drinking and smoking. Franks history reveals genetic history of non-insulin dependent
diabetes, heart disease and stroke. So considering all this Franks diet is appropriate for him as it
will control his cholesterol level.
The 2 gm Na, low fat low cholesterol, mechanical soft mainly aims at reducing levels of
triglycerides and cholesterol in blood and is used as a mean of treating and preventing coronary
heart disease. In this diet Frank will be given no more than 60g or less than 30% of the total
calories from fat. This diet will ensure that Frank gets less than 300 mg of cholesterol on daily
basis. The food menu will be part of Franks diet will include saturated fat such as, poultry fat
and meat; dairy products for instance cocoa butter, palm kernel oil, coconut oils, palm oil, ice
cream, cheese, whole milk and butter (Duyff, 2011).
6. Two months following admission Frank weighs 121bs. How much weight has he lost since
admission? What is his percentage of body weight now?

MEDICAL NUTRITION THERAPY

When Frank was admitted in rehabilitation facility, he weighed 135lbs and after two
months, his weight is 121lbs. This means that in two month time period Frank lost 14 lbs. The
idea of percentage of ideal body weight depends on various factors. First of all we calculate
patients ideal weight as a function of their age, gender and height. Then we see the percentage of
their weight and ideal weight.
Percentage of Ideal Body Weight = Original Weight/ Ideal Weight * 100
Percentage of Ideal Body Weight = 121 lbs / 147lb *100
Percentage of Ideal Body Weight = 82.31%
7. Frank's intake continues to be between 25-50%. As a dietary manager what can you do
to help Frank adjust to the facility?
First of all as a dietary manager, Frank should be given proper counseling in which the
risks associated with high cholesterol and malnutrition must be discussed in grave detail. Frank
should be adequately motivated by involving his family in his intervention. Whenever Frank
takes good amount of food intake, he should be appreciated so that through positive
reinforcement he can be motivated to increase his food intake. Moreover since Frank is very old,
so a 24 hour nurse should be appointed for his assistance.

MEDICAL NUTRITION THERAPY

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References

Duyff, R. L. (2011). American dietetic association complete food and nutrition guide. Houghton
Mifflin Harcourt.
Pinkney, J. H., Johnson, A. B., & Gale, E. A. M. (2010). The big fat bariatric
bandwagon. Diabetologia, 53(9), 1815-1822.