Case 2A: EMILY

Emily is a new admission to the VA Rehabilitation Center. Emily is a 33 year-old FBI agent recovering from multiple gunshot wounds sustained during a terrorist attack. During the incident, she was shot in the lower back and abdomen. She lost a significant amount of blood from the gunshot wounds and required blood transfusions. The surgeons had to remove a large part of her colon due to extensive damage. She has spent two months in the hospital recovering from the accident and several infections. Emily is also suffering with PTSD since the incident and has withdrawn from family and friends.

Medical Profile

Height
5 feet 9 inch (medium frame)
Weight today- 10/1/14
122 lbs.
Weight at admission to hospital 8/1/14
140 lbs.
Past Medical History
Hypertension
HCT
29%
Hgb
12 gm/dl
Pre Albumin
12 mg/dl
Total C cholesterol 165 mg/dl
Diet Order
Regular with Vegan restrictions

1. What is Emily’s IBW? What is her percentage of IBW today? How much weight has she lost since her admission to the hospital and today? Show all your work. (3 pts)

Emily’s IBW is 145 lbs. (100 lbs. = 5 ft. + 45 lbs. = 9 inches x 5 _______ 145 lbs. = IBW medium frame

Emily’s percentage of IBW is 97%. 140 lbs. / 145 lbs. = 0.965 x 100 = 96.5 or 97%

Emily has lost 18 lbs. since admission. 140 lbs. – 122 lbs. = 18 lbs.

2. What her percentage of weight change? Are you concerned about her weight change between the admission to the hospital and today? Explain. (3 pts)

Emily’s percentage weight change is 13 %.
140 lbs. – 122 lbs. = 18 lbs. / 140 lbs. = 0.128 x 100 = 12.8 or 13%

Yes, I am concern because Emily weight percentage has increased more than 10 % in 6 months which puts Emily at nutritional risk.

3. Evaluate her lab report. What does it tell you about her protein status? What does it tell you about her iron status? Emily’s doctor ordered iron supplements daily. She prefers taking this in the morning with coffee and breakfast. Is this a concern? Explain (3 pts)

Emily’s protein status indicates that it is low the normal range which indicates that she is in the mild stage of malnourishment.

Emily’s lab report reveals that her Hematocrit (HCT) is low, her Hemoglobin (Hgb) is in the normal range, but could be on the verge of being low. This could be the reason for the doctor ordering iron supplements, because of the low levels between her HCT and Hgb.

Yes, this is a concern, because coffee will block the effect of the iron supplements.

4. Determine her BEE using the Alternate Formula based on her current weight. Use an activity factor of 0.2 and an Injury factor of .5 to determine her total calorie requirements per day. Hint: Provide your answer is a total calorie per day amount. Show your work. (3 pts)

122 lbs. / 2.2 = 55 kg
55 kg x 0.9 cal/kg/hr = 50 cal/hr
50 cal/hr x 24 hr/day = 1200 cal/day (Activity) 1200 cal x 0.2 = 240 cal 1200 cal + 240 cal = 1440 cal/day

(Injury) 1200 cal x 0.5 = 600 cal 1200 cal + 600 cal = 1800 cal/day

5. Emily requests a Vegan meal plan. Explain the key points of this restriction and what food groups in particular are excluded. In the chart below, highlight the food items that would be appropriate for this meal plan. (4 pts)

The