ADIME #1

Brianne Kondratowicz
April 6, 2017

Assessment
o Patient Initials: CV Age: 34
o Gender: Female
o Patient Chief complaints: CV was admitted complaining of
worsening abdominal pain, nausea and vomiting of red fluid as well as
red diarrhea. She also complained of swelling in her right leg.
o Main Diagnosis: Acute Gastritis and Morbid Obesity
Acute gastritis is rapid onset of inflammation of the stomach and the
symptoms associated. Symptoms include nausea, vomiting, malaise,
anorexia, hemorrhage and epigastric pain. Gastritis can be caused
by H. pylori, overuse of NSAIDS or other corrosive substances such
as tobacco that could break down the mucosal lining, overall poor
nutrition and eosinophilia gastroenteritis. Treatment for non H.pylori
gastritis includes removing the inciting agent as well as possibly
providing proton inhibitors or H2 blockers to reduce acid secretion.
For H. pylori gastritis, an antibiotic is an effective treatment. To
prevent gastritis or prevent flare ups, its recommended to remove
triggers from your diet such as alcohol, tobacco, acidic beverages
such as coffee, and NSAIDS. Some recommendations to avoid
gastritis are eating a fiber rich diet, eating foods high in flavonoids
which slow the growth of H. pylori and avoiding high fat foods which
can be inflammatory.
Morbid Obesity is characterized by a BMI over 40. Individuals who
are morbidly obese are at an increased risk for diabetes, high blood
pressure, sleep apnea, GERD, gallstones, osteoarthritis, heart
disease and cancer. The first treatment option for morbid obesity is
often weight reduction through a balanced, energy restricted diet
supplemented with physical activity. Calories must be decreased to
the point where fat stores must be mobilized to meet daily energy
 needs. Generous protein is needed to ensure dietary protein isnt
used for energy. Fat shouldnt exceed 30% and carbohydrates should
be individualized. Increased fiber is recommended to reduce calorie
density, promote satiety by delaying stomach-emptying time and to
decrease to a small degree the efficiency of intestinal absorption. If
diet and lifestyle intervention doesnt work for weight loss, surgery
may need to be considered.
o Treatments:
Being treated with Lovenox
o PMHx
Asthma
Morbid obesity
o Ht: 55 Wt: 383 lbs
o IBW: 125 lbs IBW%: 306.4%
o UBW: 383 lbs %UBW: 100%
o Weight changes: none reported
o BMI: 63.9- Morbid Obesity

Nutritional Requirements:
o Kcal: Mifflin- 2930; kcal/kg (14 kcal/kg)- 2436 kcal
o Protein: 25%; 152 g
g/kg of IBW- 2-2.5 due to Obese- 250-312.5 g
o Carbohydrates: 45%; 274 g
o Fat: 30%; 81 g
o Fluid: 1 ml/kcal intake- 2436 ml

o Diet Order
Current: Regular diet
Previous
2/28: NPO due to unknown cause of N/V and red diarrhea
2/29: clear liquid/ low residue to reduce stress on GI but allow to
energy intake. Tolerated well with no N/V. Still some discomfort
but hope to advance diet within 24 hours from start of diet
The regular diet is appropriate for CV because she tolerated the clear
liquids well without N/V, therefore it was time for her to try solid food
to increase her energy intake. She tolerated the solid food with no
N/V or diarrhea so this diet is appropriate.

Labs
Date Lab Normal Patient Significance
Name Range result
3/29 BUN [8-23] 8 Adequate renal function

3/29 Creatini [0.4-1.2] 0.67 Adequate renal function

ne
3/29 Na [136-144] 141 Maintaining good electrolyte balance

3/29 K [3.5-5.1] 3.9 Maintaining good electrolyte balance

3/29 Cl [98-107] 108 H Could be high due to dehydration or

diarrhea
3/29 WBC [3.2-10.6 8.1 Proper immune system health
x1000 uL]

3/29 Hgb [12.1-15.6] 12.5 Normal blood oxygen

3/29 HCT [34-45] 38.1 Proper red blood cell production/ count
3/29 Platelet [177-406 x 230 Proper red blood cell production/ count
1000uL]
3/29 FBG [70-99] 96 Proper maintenance of blood sugar
levels; be sure to monitor so does not
become hyperglycemic
3/29 Ca [8.4-10.2] 8.1 L Could be low due to hypoalbumenemia,
diarrhea, malabsorption or vitamin D
deficiency
3/29 Albumin [3.5-5] 2.6 L Could be low due to malabsorption,
diarrhea, malnutrition or low protein
intake

Medications
o Morphine- for pain; narcotic/opiod; Drug: take with food to decrease
GI distress. Nutr: anorexia, increase thirst, dehydration. Oral/GI: dry
mouth, taste changes, dysphagia, dyspepsia, decreased gastric
motility, N/V, constipation, impaction and diarrhea.
 Nutrition Focused Physical Findings
o Skin: warm, dry, intact
o Mental: alert and oriented
o Hair: healthy, full
Pertinent Social History
o CV is a 34 Hispanic female who lives at home with her fianc and son.
She has recently quit smoking within the past 5 months and reports no
issues with drugs or alcohol. She does all of the cooking and grocery
shopping in her house. She is independent for all of her ADLs. She has
an extensive history of hospital visits ranging from mental problems to
GI issues. She has significant family history of diabetes, high
cholesterol and heart attack, though none of these are issues shes
currently struggling with.
Nutrition History
o Pt reports she does not restrict/cut down any foods in particular
o Pt stated she does not eat pork but she does eat turkey and chicken
o The only vegetables she will eat are broccoli and lettuce
o Pt states she does read food labels
o Appetite: reports good appetite when feeling okay
o She stated she has seen a dietitian before, but not during her current
stay at the hospital
Summary of Current Intake
o When met with patient she had just had her first solid meal since being
admitted to the hospital and she was tolerating it well
o Pt had just finished grilled cheese with ham and two cans of ginger ale
for lunch
o Been on NPO and clear liquids with little appetite due to pain and
discomfort prior
o At home follows normal- 3 meals a day

Diagnosis/ PES: Not ready for diet or lifestyle change related to need for
weight loss as evidenced by BMI of 63.9, little interest in change and lack
of attention paid to diet and physical activity
Interventions
o Decreased energy diet- decreasing food intake and increasing nutrient
density of foods
 o Education on how to make healthier eating choices and how to eat to
prevent certain disease states at risk for such as diabetes, high
cholesterol and heart disease
o Referral to weight loss program/support group to help with motivation
and education
Monitoring and Evaluations
o Monitor energy intake to ensure eating at an appropriate caloric level
to induce weight loss
o Monitor weight to see if weight loss is occurring- ensuring dry weight is
being measured
o Monitor albumin to make sure it returns to normal range with proper
eating. Also monitor levels such as FBG to ensure they dont rise.
o Monitor overall physical appearance to see if physical signs of weigh
loss begin to appear (around 3 months)- clothes becoming looser,
waist circumference smaller, etc.
o Evaluate patient education to ensure patient is able to list 3 sources of
lean protein to include in diet and 3 lower calorie meal or snack options

References
o Academy of Nutrition and Dietetics. Nutrition Care Manual. Academy of
Nutrition and Dietetics, 2016. Web.
o Pronsky, Zaneta, Dean Elbe, and Keith Ayoob. Food and Medication
Interactions. 18th Edition. 2015.
o Mahan, L. Kathleen and Raymond, Janice. Krauses Food and the
Nutrition Care Process. 14th Edition. 2017. Print.
o http://umm.edu/health/medical/altmed/condition/gastritis
o https://www.urmc.rochester.edu/highland/bariatric-surgery-
center/questions/morbid-obesity.aspxh
 Sample Menu- Regular Diet
Breakfast
2 eggs and 3 egg whites, scrambled
1 cup Multi Grain Cheerios with cup skim milk
3 slice of turkey bacon
1 cup fruit juice
1+ cup of water
Snack
1 Greek yogurt container (~5.3 oz) with cup of granola and cup
of raspberries
1+ cup of water
Lunch
1 light tuna salad sandwich on whole wheat toasted bread
3 oz of baby carrots with 2 tbsp of hummus
1 Diet Iced Tea
1+ cup of water
Snack
3 rice cakes and 3 tbsp of peanut butter
 1+ cup of water
Dinner
3 oz of whole wheat pasta tossed with 1 cup of steamed broccoli, 5 oz
of grilled chicken and 1 tbsp of olive oil
1 cup of skim milk
1+ cup of water
Snack
1 oatmeal cookie
1+ cup of water

Nutrient Need Calculated:

Kcals: 2436
Protein: 152 g
Carbs: 274 g
Fat: 81 g
Fiber: 25 g (DRI for women
but recommend higher due to
gastritis/obesity)