Case Study #1 Ms. X is a

Case Study #1 Ms. X is a 28-year-old woman admitted with diarrhea and dehydration. PMH: Unremarkable H&P: Four-week history of abdominal pain and cramping; diarrhea increasing in frequency over three to four weeks, now with 10 to 15 stools per day, often bloody; 25 lb. weight loss. Anthropometrics: Height 5’6″. Weight: 100 lbs. UBW: 125-130 lbs. Nutrition related lab values tested on admission are within normal limits. Course: Upon admission, the patient was made NPO and started on IVF of D5 ½ NS with 20 mEq KCI at 80 ml/hr. A GI consult was obtained and workup continued over the next several days, including UGI with SBFT, Gastrografin enema and colonoscopy. Final diagnosis was Crohn’s disease of the small bowel, including the terminal ileum. The patient was NPO for 3 days and given IV fluids. Stool frequency decreased to 3-4 times per day. Abdominal pain resolved. On HD3 a nutrition consult is ordered to evaluate nutrition status and possible elemental diet. Patient is started on IV Solu-medrol. Diet history from patient: Breakfast – coffee with milk, bagel with cream cheese Lunch – salad, diet soda Dinner – pasta with marinara sauce, salad, water or diet soda Over the past month, intake had decreased due to GI symptoms. Intake had been exclusively liquids for the week prior to admission. Avoids milk except with coffee due to “bloating” but no history of other food intolerance. Case Study #1: Questions ADIME note based on diet history and other available data. Identify any possible nutrient deficiencies. Assessment: Diagnosis: Interventions: Monitoring/Evaluation: 1. Discuss the possible side effects of the IV Solu-medrol that had been ordered, including any nutritional implications. 2. What is the role of an elemental or semi-elemental diet in treatment of Crohn’s disease? What are the limitations or barriers with this therapy? 3. On HD8 the patient is preparing to be discharged the next morning. Her physician asks you to discuss the usual diet progression with her in anticipation of her being discharged. What information do you discuss with her SCIENCE HEALTH SCIENCE NURSING NUTRITION 450

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