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ADIME #3
Tyler Leeman
Manchester Memorial Hospital
IV:
o D5W and IV fluids.
Respiratory:
o Nasal Cannula
Biopsy
o Lumbar puncture to check cerebrospinal fluid sample
Anthropometric Data:
Height: 6’1”
Weight: 165 lbs. (75 kg)
IBW: 184 lbs. (83.6kg)
IBW%: 89.6%
UBW: 172 lbs. (78.2kg)
UBW%: 95.9%
Nutritional Requirements:
Kcal/kg:
25kcal x 78.1 kg = 1954 kcal
Protein:
0.8-1.0 g/kg
0.8 x 75.06 = 60 g protein
1.0 x 75.06= 75 g protein
Fluid:
75.06 kg x 30 mL= 2251 mL
1mL/kcal
1 mL x 2071 kcal = 2071 mL
Diet order:
Patient currently on a regular diet.
Appropriateness:
I feel a regular diet is appropriate for this patient. I suggested drinking an Ensure in-between
meals and he was receptive to the idea and wanted to try it. My main goal for him would be to
increase his oral intake. I spoke with him and gave him some tips on how to increase his food
consumption through the day. Keeping snacks nearby in his room and trying to eat during the
parts of his day when he isn’t having headaches and nausea/vomiting.
Labs:
Lab Test Normal Range Patient Value Date Interpretation
Sodium 136-145 mmol/L 141 mmol/L 3-29-18 WNL, No
concern for an
electrolyte
imbalance with
this patient
Potassium 3.5-5.1 mmol/L 3.2 mmol/L 3-29-18 Low , could be
due to a GI loss
or his IV could
have been
lacking
potassium. Also
could be due to
his vomiting
Albumin 3.4-5.0 g/dL 2.8 g/dL 3-29-18 Low , could be
due to a low
protein intake
from diet or
malabsorption
BUN 7-18 mg/dL 14 mg/dL 3-29-18 WNL, no
concerns with
kidney function
with this patient
Creatinine 0.550-1.3 mg/dL 0.65 mg/dL 3-29-18 WNL, no
concerns with
kidney function
with this patient
Hemoglobin 13.5-18 g/dL 13.1 g/dL 3-25-18 Low, decreased
levels related to
his HIV/AIDS
Hematocrit 40-52% 38.8% 3-29-18 Low, Decreased
level mainly
related to
HIV/AIDS or
anemia
Platelet Count 150-480 K/uL 126 K/uL 3-29-18 Low, Decreased
level due to
HIV/AIDS or his
cryptococcal
meningitis
infection
WBC 3.7-10.3 K/uL 3.1 K/uL 3-29-18 Low, Decreased
level due to
HIV/AIDS or his
cryptococcal
meningitis
infection
Medications:
1. Amphotericin
a. Purpose: Antifungal, Cryptococcal meningitis treatment in HIV
b. Side effects:
i. Anorexia
ii. Decreased weight
iii. Nausea/vomiting
iv. Stomach pain
v. Dyspepsia
vi. diarrhea
2. Oxycodone
a. Purpose: Narcotic, Opioid
b. Side effects:
i. Anorexia
ii. Dry mouth
iii. Dyspepsia
iv. Gastritis
v. Nausea/vomiting
vi. Diarrhea
vii. constipation
3. Ondansetron
a. Purpose: Antiemetic, antinauseant
b. Side effects:
i. Dry mouth
ii. Abdominal pain
iii. Constipation
iv. Diarrhea
4. Flucytosine
a. Purpose: Antifungal
b. Side effects:
i. Chest pain
ii. Decreased urine output
iii. Numbness/tingling
5. Azithromycin
a. Purpose: antibiotic
b. Side effects:
i. Stomatitis with IV
ii. Nausea/vomiting
iii. Abdominal pain
iv. Diarrhea
Nutrition History:
Patient says he likes most food except vegetables. Intake was recently consistently low due to
constant headaches. He refused to use any dietary supplements because he wants all calories
to come from food. Patient also has a history of refusing antiretroviral therapy.
Diagnosis:
Inadequate energy intake related to poor appetite linked to headaches, nausea and vomiting as
evidenced by patient self-report of low oral intake less than 50% of meals for 3 days.
Intervention:
Food and/or Nutrient Delivery (meals, snacks, enteral and/or parenteral feeding;
supplements – as in commercial, food/drink based, or vitamin/mineral)
o Strawberry Ensure in-between meals in order to help him reach estimated calorie
and protein needs
o Frequent smaller meals instead of large meals throughout the day
o Provide energy dense snacks patient can keep nearby to increase calorie intake
when feeling well enough to eat
Nutrition Education (purpose; priority modifications; survival info; nutrition relationship to
health and disease; recommended modifications)
o Educate patient on importance of eating frequent energy dense meals and having
snacks nearby throughout the day in order to maintain weight & help return him
to his normal weight.
o Educate him on neutropenic type diet to avoid foodborne illnesses due to his
compromised/weakened immune system
Washing raw produce
Cooking foods to proper cooking temperatures
Coordination of Nutrition Care (team meeting; referral to RD with different expertise;
collaboration with other providers; referral to community agencies or programs)
o Collaborate with nursing team to explain importance of patient increasing oral
intake. Necessary to track number of food items on patient tray and amount of
each meal consumed.
o Prevent patient hunger
Meal Plan:
I would focus educating the patient on food safety and ways to eat and consume a high
amount of calories when he is feeling well enough to eat.
o Small frequent meals may work better than larger meals
Allowed:
o He is on a regular diet and the majority of foods are available for him to include
in his diet in order to increase his intake and help return him to his usual body
weight.
Not Allowed
o He should stay away from:
unpasteurized or raw dairy products
cheeses made from unpasteurized or raw milk
raw/undercooked eggs, meat or poultry
sliced deli meats
unwashed raw fruit and vegetables/unpasteurized fruit and vegetable
products (juice, cider, etc.)
roasted nuts in the shell
uncooked grain products.
With his CD4 low due to his HIV we really want to take safety measures like washing
produce and cooking meats to the proper temperature to avoid a foodborne illness
because he is at an increased risk.
When he is eating we will try to focus on high calorie foods like breaded meats, adding
sauces/gravies, and whole milk products.
Estimated Needs:
Protein: 75 g protein
References: