Krause’s Food & the Nutrition Care Process 14th edition CLINICAL CASE STUDY

Krause’s Food & the Nutrition Care Process 14th edition CLINICAL CASE STUDY

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Winifred, a 38 year old F, is seen at City Hospital emergency department

(ED). She has a history of hypertension, obesity and unsuccessful

weight loss attempts. She loves fried foods, soft drinks, beer and pretzels. She has a history of binge eating. Winifred is required to have a

yearly physical by her employer, but has put off scheduling the appointment until she can lose some weight. She fell down some stairs in a

work-related accident and was sent to the ED for observation. The emergency department doctor determined that Winifred has no broken

bones, but is concerned about her elevated blood pressure, 185/98. The

doctor orders laboratory tests and Winifred is admitted to the hospital.

Her medical pro?le today is:

Age 38 years old Normal

Height 5,1-

Weight 285 lb

Glucose 142 mg/dL; 7.8 mmol/L

Calcium 9.1 mg/dL; 2.27 mmol/L

Sodium 140 mEq/L; 140 mmol/L

Potassium 3.6 mEq/L; 3.6mmol/L

CO2 25 mEq/L/ 25 mmol/L

Chloride 96 mEq/L; 96 mmol/L

BUN 30 mg/dL; 10.7 mmol/L

Creatinine 0.9 mg/dL; 79.6 %mol/L

Albumin 3.8 g/dL; 38 g/L

Total protein 8.0 g/dL; 80 g/L

ALP 35 U/L; 0.5 %kat/L

ALT 28 units/L; 28 units/L

AST 23 units/L; 0.38 %kat/L

Bilirubin, total 1.5 mg/dL; 25.65 %mol/L

RBC 5.1 ‘ 10

6

mL; 5.1 ‘ 10

12

L

Hgb 11 g/dL; 7 mmol/L

Hct 30%; 0.30

MCV 78 mm3

; 78 fL

MCH 23 pg

MCHC 40 g/dL; 40%

WBC 8 ‘ 10 9

Total cholesterol 245 mg/dL

LDL 145 mg/dL

HDL 30 mg/dL

Triglycerides 210 mg/dL

Winifred is referred for medical nutrition therapy. NFPA indicates a

robust female, with excessive fat stores, normal muscular development

and no ?uid accumulation. Assess her nutrition status using the data

provided.

Nutrition Diagnostic Statement

Altered laboratory values related to disordered eating pattern as evidenced

by signs of nutritional anemia and dyslipidemia.

QUESTIONS:

6. What does the lab value for glucose (non-fasting) suggest?

7. What additional lab test would be helpful to confirm answer to #6?

8. You measure Winifred’s waist circumference as 38 inches, what additional information does this provide?

9. What is Winifred’s WHtR?

10. You suspect Winifred has inflammation, what will happen to her positive and negative acute phase reactants if inflammation is present?