Beruflich Dokumente
Kultur Dokumente
FSN 429
ADIME: Brigit
October 7, 2015
9:26pm
Assessment:
17 YO female referred by MD after complaining of chronic fatigue, tingling in the extremities, pale skin,
increased appetite. Has recently suffered a decreased running performance and has trouble
concentrating. Patient is immunocompromised as she cant recover from a cold. Has low but normal
level of serum iron at 31 g/dL, low H and H at 33% hematocrit and 9.5 g/dL hemoglobin. Ferritin and
RBC count are at normal level. Has low transferrin at 2.2 g/L and high total iron binding capacity at 475
ug/dL. MCV is low at 73 fL. MCH is low at 22 pg/cell. Labs show patient has hypochromic microcytic iron
deficiency anemia. Patient is high school athlete playing on varsity volleyball team and runs track.
Diet Hx: (from 24 hour recall) Currently consuming caloric intake that is slightly high than her estimated
energy needs at 51 kcals/kg but the patient is highly active and has not gained weight. Protein
consumption is adequate at 1.8 g protein per kg body weight. Diet does contain some fruit and
vegetable consumption. ~58% of kcals consist of CHO with 460g consumed, ~14% of kcals consist of
protein with 112g, ~32% of kcals consist of fat with 133g consumed. Diet is adequate in macronutrient
consumption but is inadequate in iron rich foods such as meat, beans, or dark leafy greens.
Anthropometrics:
Wt: 61.36 kg
Ht: 167 cm
BMI: 22 (normal)
IBW: 136 lbs
%IBW: 100% (normal)
TSF: 10 mm (at 10th percentile, below average fat stores)
MAMA: 41.57 cm^2 (between 85th-95th percentile, above average musculature)
Glucose: 112mg/dL (high but not fasting blood glucose)
Fe (serum): 31 g/dL (low but normal)
Hct: 33% (low)
Hgb: 9.5 g/dL (low)
Ferritin: 150 g/L (normal)
RBCs: 4.5X10^12/L (normal)
Transferrin: 2.2 g/L (low)
TIBC: 475 ug/dL (low)
MCV: 73 fL (low)
MCH: 22 pg/cell
MAC: 25 cm
Estimated kcal needs for maintenance: about 31000 kcals (according to Mifflin-St. Jeor method
and an AF of 2.2) and 37 kcals/kg weight consumed
Estimated Protein needs: 92 grams or 1.5g per kg body weight
Estimated CHO needs: about 55% of kcals or about 426 grams/day
Estimated Fat needs: about 25% of kcals or 86grams/day
Estimated fluid needs: 2135-2440 ml/day
Patient seems motivated to make changes to diet to improve athletic ability and perform better in
school.
Diagnosis
PES:
1. Inadequate iron intake related to low consumption of iron rich foods as evidence by 24 hour
recall
a. Increase iron intake by:
i. Taking 30 mg ferrous iron supplement 1-2 times a day
ii. Increase vitamin c consumption by consuming vitamin c rich foods at each
meal
2. Food and nutrition knowledge deficit related to vegetarian diet as evidence by patient
report
a. Increase nutrition education by:
i. Performing quiz on food labels
ii. Performing food frequency questionnaire
Intervention
Goal:
1. Increase consumption of iron
2. Increase protein consumption to 155 grams a day
3. Improve nutrition education on an iron rich diet
Recommendations:
Provide education on high iron diet and iron content of diet to improve blood labs.
Diet to provide 3100 kcals and 155 grams of protein a day with a 30 mg iron supplement taken
1-2 times a day with vit c.
Monitoring & Evaluation
Monitor:
Indicator
1. Iron intake
RD to monitor and evaluate energy intake for increase of transferrin, MCV and MCH.
Evaluation:
RD to follow up in 1 week. Monthly visits for first 6 months of diet. Blood test for iron levels should be
conducted in 3 months to monitor levels.
Sarah Alarid, R.D.
October 7, 2015