NUT116BL - Due: 1/20/2017 Name: Karina Almanza

Mini Case Study #1 - 20 points possible

1. Please be concise and use the space provided. Type your answers
2. Please cite sources as necessary.
3. You may use your textbook, the pocket guide, and FMI book.

Present illness: Mr. G is a 71 yo retired computer engineer who has had

constipation off and on for most of his adult life. He recently has had
episodes of cramping LLQ pain. No fever. No weight loss.
CC: Rectal bleeding and bright red blood in bowel movements x 4 d.
Colonoscopy reveals numerous diverticula and evidence of inflammation and
bleeding from diverticula in descending colon.
Dx: Diverticulitis with GI bleed p. 423
Anthropometrics: Height 59, Weight 180#
Labs: Albumin 3.2 g/dL slightly below normal range (3.5-5.0) p. 534
Hgb 10 g/dL below reference range (14-18) p. 534
Hct 33% slightly below normal range (42-54) p. 135
Ferritin 49 g/L WNL
WBC 12,000/mm3 Inflammatory values p. 677
Meds: Pt to begin ciprofloxacin BID x 14 d.
Diet: Clear liquids, ADAT upon recommendations of RD. Nutrition consult
ordered.

1. How does diverticulitis differ from diverticulosis? (2 points)

- Diverticulosis is the development of small, bulging pouches, out-

pockets or sacs appear in the surface of the small intestine or colon
- Diverticulitis is the acute inflammation or infection of one or more
pouches (seen in diverticulosis) in the diverticula

Citation: NTP p. 423, 380

2. What dietary progression would you recommend for Mr. G over the next 1-
2 weeks? (1 point)

- Progress from NPO to clear liquid diets (possible antibiotics if

necessary) and eventually a low-reside or low fiber diet until
inflammation and bleeding are no longer present.

Citation: Nutrition Pocket Guide p. 50

3. Describe 2 possible drug-nutrient interactions with the drug ciprofloxacin

(2 points)
 1. Complications with Calcium and dairy products
a. Divalent or trivalent cations, milk, yogurt, enteral products of Ca
fortified food decrease drug absorption and bioavailability
2. Complications with caffeine
a. Limit or avoid caffeine/ xanthine which both cause the drug to
increase caffeine effect

Evaluate Mr. Gs usual dietary intake and answer questions 4-10 according to
the nutritional guidelines for management of diverticulosis.

Breakfast: 2 slices white toast with butter and jam; 1 fried egg; black coffee
Lunch: 1 cup soup or sandwich; sometimes leftovers from previous day;
soda
Dinner: 3 oz. beef, pork, or poultry; cup steamed vegetables (usually peas
or green beans); 1 cup noodles or potatoes; water
PM snack: 1 slice pound cake with 1 scoop vanilla ice cream; black coffee

4. What is the RDA for fiber intake for adults? How much fiber is
recommended for a patient with diverticulosis? (1 point)

- RDA for fiber intake of adults:

o Men (>70 yo): 30 g/D
o Men (14-50 yo): 38 g/D
o Women (18-50 yo): 25 g/D
- A high fiber diet of 6 to 10 g/ D in addition to 25 to 35 g/ D is
suggested to the pt w/ diverticulosis. An estimated total of 31 to 45 g/D
of fiber.

Citation: https://www.dietaryfiberfood.com/dietary-fiber/fiber-rda-rdi.php
Nutrition Pocket Guide p. 50

5. Approximately how many grams of fiber does Mr. G consume on a typical

day? List the foods and their approximate values. (1 point)

Breakfast:
- White Bread: 2 grams
Lunch:
- (Vegetable) Soup: 3 grams
- Sandwich: 8 grams
Dinner:
- Steamed Vegetables: 6 grams
- Potato: 2 grams
Total: 21 g/ D
Citation: MyFitnessPal food calculator
6. List four good sources of dietary fiber that would be appropriate for Mr. G,
and give the fiber content in 1 serving of each. (4 points)

1. Baked Sweet Potato: 7 grams per medium potato

2. Steamed Vegetables: 8 grams per cup
3. Whole wheat bread: 2 grams per slice
4. Raw vegetables (broccoli): 3 grams per cup

Citation: MyFitnessPal food calculator

7. Would you recommend a fiber supplement to this patient and why/why

not? (1 point)

Yes I would recommend a sort of fiber supplement if the pt is not willing to

make dietary changes to increase fiber intake. Currently, pt has a very low
fiber intake compared to the recommended amount for diverticulosis of 36 to
40 g/D. Once the pt is able to meet the recommended amount of intake with
diet alone, the pt does not need to include fiber supplementation in his diet.
It is preferred the pt consumed fiber from the food but supplementation acts
as a good temporary source.

8. What are two key micronutrients that appear to be limited in Mr. Gs usual
diet? - And list a food source for each that you could recommend. (2
points)

1. Iron: Foods like spinach or other dark leafy-greens, lentils, red meat,
shrimp
2. Calcium: dark leafy greens, bok choy, fish, almonds, green beans,
broccoli, tofu
a. Concern for calcium due to medication complication. Therefore,
chose vegetable-based sources of calcium rather than dairy-
based to avoid further complications with medication.

Citation: NTP p. 135 and 534

9. Nutritional Diagnosis: Write 2 appropriate PES statements from the intake

domain for this patient. (3 points)

1. Excessive fat intake (NI- 5.6.2) r/t food and nutrition knowledge deficit
AEB frequent ingestion of high fat foods and 24 hr recall
2. Inadequate protein intake (NI- 5.3) r/t loss of iron-store AEB
biochemical laboratory values for hmg and hct not meeting normal
range
10. Give three important MNT goals that you would recommend in the
Intervention part of an ADIME note as part of a long-term nutrition care
plan for Mr. G. (3 points)

1. Consume 36 to 40 grams of fiber a day; preferably through 6 to 11

servings of whole grained foods, and 5 to 8 servings of fruits and
vegetables daily.
2. Reduce fat intake by preparing meals during weekends instead of
purchasing food during the week
3. Consume 2 qts of water daily