ML is an 84-year-old, male admitted with Cerebrovascular Accident. His family reports that he has a long history of 
alcoholism with little to no intake for prolonged period. After the first 36 hours of admission, he remains aphasic and shows definite signs of dysphagia. The patient gains consciousness after Medical Management within 48 hours of hospitalization. Then the patient complains of a history of Stomach pains and diarrhea with bloody stool, for about two months.
DIET: Nil per Os (Nothing by Mouth)
Past Medical History: Liver Cirrhosis, Hypertension
Medication: Heparin gtt, Plavix, Lopressor
Height 70 inches.”
Weight 153lbs
Usual Body Weight 180lbs
Lab Results: ESR 50mm/hr, Alanine Aminotransferase 360, Albumin 3.1, Aspartate Aminotransferase 180, Hemoglobin/Hematocrit 10.1/31.
Further Diagnosis: Stool for Occult Blood- Positive
Case Study Questions:
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What are ML’s nutritional needs?
The BMI for ML is at 23.9 at now indicating normal weight for his age. However, the Usual BMI is 25.8 indicating that he is overweight generally. The percent usual body weight is 15%, which is severe weight loss. Therefore, the patient needs to be stabilized to avoid further weight loss. ML requires supplemented vitamins for the underlying Crohns disease. Arguably, the patient’s Hemoglobin levels are slightly lower for an average male his age. Still, there is evidence of blood loss due to the presence of occult blood in the patient’s blood. Therefore, Iron will be needed to help maintain Hemoglobin levels, might need for Surgery arise to remove the ulcer from his gastrointestinal tract. Patients with Crohns disease have an impaired absorption of nutrients from their gut and therefore need Nutrient supplements, especially vitamins (Haries et al., 2010)
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What is the intervention you would recommend? What route of feeding? Why? Include rate/formula.
Exclusive enteral feeding. This would see that the patient feeds on liquid formula. It will reduce instances of gastrointestinal system blockage, and the formula will provide all the needed nutrition for the patient maintenance (Nimbal Therapy, 2016). Presumably, the Enteral Feeding rate for the patient would be
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What are some nutritional concerns in this case? What would you recommend?
The patient is losing iron through occult blood and with time, the patient’s Hemoglobin/Hematocrit levels will go low. The patient has to be maintained on Iron supplements and vitamin B 12, 1mg per day. Furthermore, Enteral feeding may have to be restricted if the patient will have to undergo a surgical procedure.
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Which nutrition assessment parameters would you use?
The biochemical nutritional markers would be the gold standard for the management of the patient after a Cerebrovascular disease. Therefore, Albumin will have to monitored, which at admission, was slightly lower indicating poor feeding of the patient. Also, physical body markers such as weight and the Body Mass Index would be helpful in the monitoring of the patient response to nutritional interventions (Donnelan, Yann, & Lal, 2013).
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Write a nutrition diagnosis for this patient
Protein energy malnutrition (Albumin < 3.5), Unintentional weight loss (Severe weight loss, More than 10% of weight lost) with Gastrointestinal symptoms (Diarrhoea) and loss of appetite
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What is the nutrition intervention for this patient?
The patient will increase energy intake to 1800 kcal per day for analysis of adequacy.
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What is going to be the monitoring and evaluation parameters for this patient?
The patient will need to be monitored for response to nutritional intervention, checking for the improvement of the Patient’s Hemoglobin levels and Stabilization of the patient’s weight.
Write ADIME note
ADIME NOTE
- Patient Name: ML
- Patient Age:84
- Patient Sex: Male
- BMI: 23.9
- Date of Admission:
Assesment
Poor appetite, Diarrhea, Weight loss
Patient with suspected Crohn’s disease.
Diagnosis
Protein energy malnutrition (Albumin < 3.5), Unintentional weight loss (Severe weight loss, More than 10% of weight lost) with Gastrointestinal symptoms (Diarrhoea) and loss of appetite
Intervention
The patient will increase energy intake to 1800 kcal per day for analysis of adequacy.
Monitoring
Monitor the energy intake of the patient daily
Evaluation
Improved feed intake, and improved body weight
-Assessment-Diagnosis (Nutrition)-Intervention-Monitoring
Write Follow Up Note for Day 2
Nutrition Follow-up note
Diet Order: Eternal
Nutritional Lab Values: Labs remarkable for Potassium: 3.2, Cl: 90, Co2: 38, BUN:56, Cr:1. Assessment
The patient is an 84-year-old male admitted with a cardiovascular injury. He regained consciousness recently. The patient is currently on Enteral Nutrition, complaining of loss of appetite and chronic abdominal pains.
Nutritional Diagnosis
Protein energy malnutrition, Unintentional weight loss with Gastrointestinal symptoms and loss of appetite r/t Suspected Gastrointestinal Ulcer
Recommendations Diet:
Continue enteral feeding with increased energy intake, 1800 kcal. Maintain Supplemental Iron, 15 mg bid and Folic acid, 1mg once daily
Nutrition trending:
Weigh daily and Monitor Body Mass frequency. Suggest Laboratory monitoring of Hemoglobin Levels.
Nutrition Goals:
1.Patient Normal feeding
2.Improve the patient Weight
3. Improve Hemoglobin Values
Name; Description
References;
- Nimbal Therapy, (2016). Exclusive Enteral Nutrition Therapy. Nimbal.org. Retrieved 29 March 2017, from https://www.nimbal.org/education/what-is-ibd/exclusive-enteral-nutrition-een
- Stroud, M., Duncan, H., & Nightingale, J. (2008). Guidelines for enteral feeding in adult hospital patients. BMJ Journals, 52(7). Retrieved 29 March 2017, from https://gut.bmj.com/content/52/suppl_7/vii1
- Harries, A., Brown, R., Heatley, R., Williams, L., Woodhead, S., & Rhodes, J. (2010). Vitamin D status in Crohn’s disease: association with nutrition and disease activity. Gut, 26(11), 1197-1203. doi:10.1136/gut.26.11.1197
- Donnellan, F., Yann, L., & Lal, S. (2013). Nutritional management of Crohn’s disease. Therapeutic Advances In Gastroenterology, 6(3). Retrieved 29 March 2017, from https://journals.sagepub.com/doi/abs/10.1177/1756283×13477715