Chapter 26 Case Study Assignment
Review the case study information and type your answers toquestions 1-3 below.
Suzie is a 55-year-old female who is referred to the outpatientclinic with dumping syndrome that has started to interfere with herdaily life. She travels for work, and keeping up with her busyschedule has become more difficult with symptoms at unpredictabletimes when she needs to be driving or in a meeting. A nutritionconsultation with a registered dietitian specializing ingastrointestinal disorders is requested by her thoracic surgeon tohelp with relief of symptoms.
Nutrition assessment
• Medical History: a short bout with dumping syndrome in 2014after a Nissen fundoplication for a hiatal hernia that resolved ashort period after surgery. After a minor hernia repair surgery toredo the fundoplication in early 2018, she began experiencing itagain but with more severity. Symptoms include sudden weakness,shakiness, and hunger. She has occasional nausea during episodes,but no vomiting. Other history includes elevated blood pressurethat she reports controlling with diet, heartburn, and bloodglucose levels within normal limits unless she is having a dumpingepisode, when it dips as low as 30 mg/dL.
• Medications: Tums and Omeprazole
• Nutrition History: Suzie travels for work as a sales managerand is on the road constantly, eating mostly packaged and preparedfoods on the go, and frozen dinners at home since she lives aloneand does not enjoy cooking. Immediately after her fundoplicationsurgery she ate only soft foods but has recently graduated to somemore–normal texture foods after ok from her surgeon to do so. Sheis unable to determine any food triggers for her dumping with herfood journal and has not documented how soon an episode happensafter eating. She tries to eat 6 smaller meals per day because herdoctor told her this would be better. She also stays well hydrated,drinking at least one 24-ounce water bottle with each meal. She metwith a registered dietitian once but says the dietitian did notspecialize in this condition, so it was not as helpful as she wouldhave hoped. She is mostly vegetarian but occasionally has fish orchicken. She says she is not opposed to eating meat but mostlyavoids cooking it. She is open to nutrition recommendations andarrives at the appointment ready to learn.
• Dietary recall:
• Breakfast: She has coffee with creamand one slice of toast with butter or jam before leaving to driveto an adjacent city for a few hours for meetings.
• Snack: In the car, she has a coolerpacked with applesauce, peach cups, or a banana, of which sheselects one or two for a snack midmorning.
• Lunch: She stops at a grocery storedeli and has her favorite on-the-go meal, a large plate of macaroniand cheese, or sometimes has a chef salad now that her doctor hasallowed her to eat regular-texture foods again. She eats the mealin her car most days.
• Snack: In the afternoon she eatsanother of her cooler items, and occasionally has a string cheesethat she picked up at the grocery store deli.
• Dinner: Frozen meal of Michelina’sfettuccine Alfredo, which she describes as high protein. She mayalternate out with another frozen pasta meal if she wants somevariety, but the nutrition is about the same, according to her.
• Anthropometrics: Height: 170.2 cm (67 inches); Weight: 66.4 kg(146 lb); body mass index (BMI): 22.9 kg/m2 • Usual Body Weight:68.2 kg (150 lbs); weight change: 2.6% decrease in 3 months(clinically insignificant)
• Nutrition Focused Physical Assessment: No evidence of muscleor fat loss; no lower or upper extremity edema. Tongue is sore andinflamed. Her nails are brittle and her skin is very pale.
• Functional Capacity: Unable to exercise over the past fewmonths due to fatigue and low energy. She is feeling more forgetfullately as well and has to write everything down.
• Laboratory Data: Blood glucose: 70–100 mg/dL at fastinglaboratory draws, only drops low temporarily during dumpingepisodes; blood pressure: 144/92 (H)
Nutrition diagnostic statements
• Food- and nutrition-relatedknowledge deficit (P) related to lack of prior relevantnutrition-related education (E) as evidenced by (S) intake of manyrefined carbohydrate foods in the setting of dumping syndrome
• Undesirable food choices (P) relatedto lack of prior exposure to nutrition-related information (E) asevidenced by (S) elevated blood pressure, intake of high-sodiumfoods
Questions
- Compose another nutrition diagnostic statement in PESformat.
- List at least three nutrition interventions for Suzie.
- What would you monitor at a 1-month follow-up with Suzie?
