DFN 348 Spring 2021GERD Case Study

Please write Nutrition Assessment in ADIME format

36-year-old female post-op (x 3 months) Roux-en-Y gastric bypass surgery visits RDN at outpatient clinic.PMHx:Obesity, HTN, prediabetes, GERD, hyperlipidemia. Chief compliant of nausea and continued acid reflux.Patient reports trying to follow a "healthy" diet.States that she is rushed at dinnertime and often chooses a frozen meal with a small glass of chocolate milk before going to bed. 24-hour recall - breakfast Carnation instant breakfast with low-fat milk,English muffin with jelly, coffee; lunch - tuna or turkey sandwich with lettuce, tomato, whole wheat bread, mayo, iced tea; dinner - frozen meal or spaghetti with marinara sauce (2 cups), cooked broccoli (1 cup), orange juice (6 oz.)Ht:5'9" CBW 220#Pre-op weight 246#BMI 36Meds:Prevacid, Vit B12, Vitamin D, Ca+, MVILabs:Glu 122 mg/dL, Total Chol 225 mg/dL, LDL 125 mg/dL, HDL 35 mg/dL, TG 250 mg/dL

PLEASE FOLLOW UP THIS STEP THIS IS ONE EXAMPLE: IS THERE SOME PART THE CORRECT ALREADY

A:48-year-old male referred by MD for dx of GERD.History of disease:Ingestion x 1 year (currently constantly) self-treated with TUMS.Sedentary due to knee surgery with 35# weight gain. Reports excess eating and drinking x 1 year due to stress.Does not follow any specific diet.

A: 48 y/o male visited MD for evaluation and treatment of increasing sever indigestion, ongoing for the last year, previously at night but now almost constantly. Barium swallow shows patient has gastro esophageal reflex disease.

PHMx: Knee surgery X 1year, HTN

Meds: Tums several times a day; Atenolol 50mg day; 325mg Aspirin/day; MVI; 500mg ibuprofen BID X 1 month; omeprazole 30mg every a; decrease aspirin to 75 mg day; D/C self-medication of ibuprofen daily. Well done

Labs: Cholesterol 220, HDL 20, LDL 165, glucose 110

Dx: GERD

Social Hx: College educated, married (wife cooks) with 2 sons, retain manager of local department store, M-F, works consistently in evening and on weekends Alcohol: 1-2 beers 3-4 times per week.

Diet Hx: Patient does not follow any diet restrictions, admits to excessive energy intake over the past year, usual intake reveals high fat, sodium consumption, high sugar content and excessive amounts of fast foods due to busy schedule. Patient also revealed fried foods seem to make symptoms worse. Patient's reported usual intake is estimated at around 3400Kcal/day. Good job.

Anthropometrics: Ht: 5'9 (172.26 cm), Wt: 215# (97.72 kg), UBW: 180# (81.65 KG), IDW: 160# (72.56), 19.4% unintended weight gain x 1 year, BMI: 31.7 kg/m²

Estimated Nutrient Requirements: EER: 2000- 2200 kcal. EPR: 78g/day. Fluid Requirement: 2000-2200 ml.

Diagnosis:You must review PES - you need to use appropriate nutrition diagnosis terminology, and write the correct sentence using the approved connector work P related toE as evidenced by S.None of these are correct -10

D: Excessive energy intake as evidence by patient's self-reported current dietary consumption estimated at 3400kcal, which is 1200kcal in excess of patient's estimated needs. Missing E

Food and Nutrition related knowledge deficit as evidence by patient's self-reported usual dietary consumption of foods, which cause and make symptoms of indigestion and subsequent GERD diagnosis worse. Missing E

Unintended weight gain/obesity Remove of 35# (19.4% of UBW) within a year and a BMI of 31.7 kg/m² related to excessive energy intake as evidence by patient's reported eating and drinking more high fat foods, sodas and alcohol over the past year; and a sedentary lifestyle as a evidence by limited mobility due to knee surgery.S supports weight gain # in one year and BMI; also CBW & UBW

Altered GI function caused by the lining of patient's esophagus being exposed to acidic contents of the stomach related to consumption of high fat foods, alcohol, carbonated beverages, patient's complaints of worsening indigestion after eating fried foods and medical diagnosis of GERD.

Intervention:Diet first kcal level and grams of fat

2,200 kcal, 50-gram fat diet

Verbal and written education on foods to avoid that will worsen GERD symptoms; foods high and low in fat content; examples of lower-fat foods and how to read a food label; portion size education

Education dug/nutrient interaction - take omeprazole 30 to 60 minutes before a meal

c/w MVI

Recommend baseline values for Ca+, Fe+ and Vitamin B12

I: -2Educate patient on appropriate portion sizes needed for weight loss

Encourage patient to keep a food symptom diary to recognize how he felt after eating foods logged in diary.

Create realistic meal plan with patient to help with weight loss of:

About 1-2 pounds per week for the next 3 months

About 5% of baseline body weight over 6 months

About 10% of baseline body weight over 12 months

Diet plan based on 1 pound per week:

Provide patient with a diet plan of 2900 kcal/day (This is a higher number than your estimated needsjQuery22404479719985624082_1620063886092????); 500kcal deficit for 3 months.

Recommend a macro distribution of 55% CHO, 14% Protein and 31% Fat.

Recommend smaller portions of up to 5 meals pre day, using the following meal plan template as a guide:

Breakfast: 25% of daily total kcal intake

2 packets cooked oatmeal

2 tablespoons raisins

1 cup soy milk

Water

Caffeine-free herbal tea (not made with peppermint or spearmint)

Snack 1: 5% of daily total kcal intake

6 oz. apple juice

1 oz. low-fat cheddar cheese

4 whole-wheat crackers

Lunch: 40% of daily total kcal intake

2 oz. cooked chicken, for salad

1 cup lettuce

Low-fat dressing

1 small corn muffin

1/2 cup bananas, sliced

1/2 cup blueberries

1 diet soda

Water

Snack 2: 10% of daily total kcal intake

4 whole wheat crackers

2 tablespoons hummus

12 cup blueberries

Water

Dinner: 20% of daily total caloric intake

Pasta primavera: 1 cup pasta

1/4 cup tomato

1/4 cup zucchini

1/4 cup broccoli

1 plain bread stick

1 baked apple, peeled with cinnamon

Water or

1 cup nonfat milk

Verbal and written education on foods Educate and provide patient with a list of foods Remove to avoid in order to alleviate the symptoms of GERD such as: - High fat foods, carbonated drinks, spicy food, alcohol, citrus fruits and juices

Encourage patient to reduce/replace consumption of carbonated beverages, alcohol and citrus juices during meals with more water.

Recommend patient contact his Doctor for a referral to a physical therapist to help him with his knee pain Refer to MD for exercise clearance and PT for exercise RX

Encourage patient to contact me via e-mail or telephone with any questions or concerns

Goal: Monitor and evaluate the progress of diet/weight loss intervention during 3 week check up and make adjustments as needed.

Schedule 3 week follow-up appointment

Goal: Request patient's wife accompany him to follow-up appointment so that she can also be educated on healthy meal options, grocery shopping methods, cooking and the benefits of eating at home to further patient's success.

Monitor/Evaluate: -2

M/E: Monitor and evaluate the progress of patient's weight and BMI on diet plan

Monitor and evaluate food symptom diary for trigger foods and make diet modifications where necessary

Monitor and evaluate lipid panel and serum glucose values

Monitor Weight