NUTR 4312 In-Class Assignments #4: Case Study Mrs. B Is Admi

NUTR 4312 In Class Assignments #4: Case Study Mrs. B is admitted to your

Nutr 4312 in Class Assignments 4 Case Study Mrs. B is admitted to your acute care facility for treatment of multiple pressure ulcers. She has a stage IV pressure ulcer on her R. heel, a stage II on her L hip, and a stage III on her sacrum. The wounds have shown little or no improvement over the last three weeks, and the stage II on her L hip developed recently. The area below the R heel wound is cyanotic, indicating compromised blood flow, and amputation may be necessary.

Mrs. B's temperature has been persistently around 100°F, and she is on antibiotic therapy for an infected heel wound. She has been a long-term resident of a nursing facility due to a diagnosis of progressive Parkinson’s disease. Her weight has decreased by 12 pounds in the past month and 25 pounds over three months, with poor appetite. She is dependent upon others for feeding and often refuses meals. Mrs. B cannot walk and can only transfer into her wheelchair with assistance. A physician has ordered a dietary consultation to assess the need for tube feeding.

Clinical observations show Mrs. B is alert and responsive. She reports eating all she can but feels not very hungry. She previously signed advance directives declining artificial feeding. Chart data include: admit weight 98 pounds, usual body weight (UBW) 123 pounds, height 5'5" (self-reported), age 77, diagnoses including pressure ulcers, Parkinson's disease with mild dementia, anemia, dysphagia, peripheral vascular disease (PVD). Laboratory results are: albumin 2.4 mg/dl, prealbumin 6.8 mg/dl, BUN 32 mg/dl, creatinine 0.9 mg/dl, hemoglobin 9.2 g/dl, hematocrit 11.0%.

Paper For Above instruction

Introduction

This case study presents a comprehensive nutritional assessment and planning for Mrs. B, an elderly patient suffering from advanced pressure ulcers coupled with chronic conditions such as Parkinson’s disease, anemia, and dysphagia. Proper nutritional support in such complex cases is vital for wound healing, immune function, and overall health improvement. This paper will calculate key anthropometric measurements, estimate nutritional requirements, clarify associated medical terminology, prioritize nutritional problems, and understand the dietary modifications necessary, notably pureed diets.

Calculations of Anthropometric Data

Initial assessments include calculating Ideal Body Weight (IBW), Body Mass Index (BMI), percentage of IBW (%IBW), and percentage of usual body weight (%UBW). The formulas used are standard in clinical nutrition:

IBW (Robinson Formula for women): 45.5 kg + 0.9 kg for each inch over 60 inches.

For Mrs. B, height: 5'5" = 65 inches.

IBW = 45.5 + 0.9 × (65 - 60) = 45.5 + 4.5 = 50 kg.

Convert to pounds: 50 kg × 2.2 = 110 pounds.

BMI = weight (kg) / height (m)^2.

Her current weight: 98 lbs = 44.5 kg; height: 5'5" = 1.65 m.

BMI = 44.5 / (1.65)^2 ≈ 16.3 kg/m^2, indicating undernutrition.

Percentage IBW = (current weight / IBW) × 100 = (98 / 110) × 100 ≈ 89.1%.

Percentage UBW = (current weight / usual body weight) × 100 = (98 / 123) × 100 ≈ 79.7%.

These calculations highlight significant weight loss and potential malnutrition.

Nutritional Requirements

Estimating caloric needs involves recognizing her catabolic status, wound severity, and activity level. The Harris-Benedict equation adjusted for stress factors is appropriate:

Basal Energy Expenditure (BEE) for women = 655 + (9.6 × weight in kg) + (1.8 × height in cm) – (4.7 × age).

Applying her data: 655 + (9.6 × 44.5) + (1.8 × 165) – (4.7 × 77) = 655 + 427.2 + 297 – 362 = 1017.2 kcal.

Considering her wound healing, infection status, and age, apply a stress factor (~1.2 to 1.3):

Estimated caloric needs ≈ 1.3 × 1017.2 ≈ 1322 kcal/day.

Protein requirements are elevated in wound healing and infection; typically 1.2–2.0 g/kg IBW:

Protein = 1.5 g × 50 kg (IBW) = 75 grams/day.

Fluid needs are often calculated at about 30–35 mL/kg:

Fluid = 35 mL × 44.5 kg ≈ 1560 mL/day.

Adjustments should be considered based on her clinical status and laboratory findings.

Medical Terminology

a. Dysphagia: A medical condition characterized by difficulty swallowing, often caused by neurological disorders, structural abnormalities, or muscular issues, which increases risk for aspiration and malnutrition.

b. PVD: Peripheral Vascular Disease, a circulatory disorder involving narrowing or blockage of blood vessels outside the heart and brain, leading to poor circulation, wounds, and increased risk of tissue necrosis.

c. Parkinson’s Disease: A progressive neurodegenerative disorder affecting movement, characterized by tremors, rigidity, bradykinesia, and postural instability. It often involves cognitive decline and dysphagia, complicating nutritional management.

Prioritization of Nutritional Problems

Given her clinical picture, two primary nutritional problems are:

  1. Malnutrition and weight loss, evidenced by her 22% reduction in UBW and laboratory markers such as low albumin and prealbumin, impairing wound healing and immune response.
  2. Dysfunctional swallowing (dysphagia), increasing risk for aspiration pneumonia and limiting oral intake, necessitating modified diets and possibly enteral nutrition.

Addressing these issues involves nutritional support to promote weight gain and wound healing while managing her dysphagia with appropriate texture-modified diets.

Pureed Diet Description

A pureed diet involves blending foods into a smooth, pudding-like consistency, facilitating swallowing for individuals with dysphagia. It eliminates the need for chewing and reduces aspiration risk but must be nutritionally adequate, appealing, and safe. This diet typically includes pureed fruits and vegetables, minced meats, and dairy, with thickened liquids to ensure safety and hydration.

In Mrs. B’s case, a pureed diet is essential to ensure she receives adequate nutrition despite her swallowing difficulties and decline in oral intake.

Conclusion

Through comprehensive assessment, calculation of nutritional needs, understanding of medical terminology, and prioritization of health problems, individualized nutritional therapy can be developed for Mrs. B. Addressing her malnutrition, wound care, and dysphagia with tailored interventions including a sterile, high-protein, calorie-dense pureed diet and possibly considering enteral nutrition options will promote healing and improve her quality of life while respecting her advance directives.

References

  • Berry, D., & Gamino, J. (2010). Nutritional management of pressure ulcers. Nutrition in Clinical Practice, 25(4), 410-420.
  • Elia, M. (2003). Screening for malnutrition: a multidisciplinary responsibility. Development of a simple malnutrition screening tool for adult patients in hospitals. Clinical Nutrition, 22(3), 273-274.
  • Franzo, A., et al. (2013). Management of dysphagia in elderly patients. Geriatrics & Gerontology International, 13(3), 529-540.
  • Gordon, C. M. (2014). Clinical aspects of Parkinson's disease. Primary Care Reports, 20(3), 8-12.
  • Gupta, S., & Shah, N. (2019). Pressure ulcers: prevention and management. Indian Journal of Plastic Surgery, 52(2), 122-129.
  • Keller, H. H., et al. (2010). Nutritional support and wound healing. Journal of Wound Care, 19(6), 236-245.
  • NRS 2002. (2018). Nutritional Risk Screening 2002. World Health Organization.
  • Preiser, J. C., et al. (2015). Nutrition in the management of pressure ulcers. Clinical Nutrition, 34(4), 747-754.
  • Sorensen, L. T., et al. (2002). Nutritional risk and wound healing. International Journal of Surgery, 1(2), 85-90.
  • World Health Organization. (2011). Management of Parkinson's Disease: a guide for clinicians. WHO Press.

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