Case study

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NFS 4313 – Advanced Nutrition Micronutrient Spring 2021

Case Study Assignment 1 (60 points) Due Date – February 28th, 2021 (Submit Via Turnitin on Canvas) by 11:59 pm

Directions: The case study assignment must be completed in a question/answer format not a report format. Please type each question as written below followed by your response immediately after the question. DO NOT TYPE INFORMATION FROM CASE SCENARIO, LAB VALUES, OR ANTHROPOMETRIC INFORMATION Please limit your assignment to no more than 3 pages including reference section (1 inch margins, single spaced, size 11 Times New Roman or Arial Font) total including the citations (reference/bibliography) section which should be at the end of your assignment after the last response. Citations used in your assignment are to be numbered (numerical order) within the statements (responses) and they should follow that numerical order in your bibliography section at the end of your assignment. The formatting of the cited work must be consistent and will be evaluated as part of your submission. PLEASE NOTE: Do not submit a cover page for this assignment. It will be counted against your three page limit. Have your full name on the first page top right corner of the assignment. The assignment will be evaluated for:

 concise in addressing the question as stated  format and guidelines  completeness and accuracy of your response  sentence structure and grammar  critical thinking and supportive knowledge

Case Scenario

Holly is a 22 year old woman who had a gastric bypass (Roux-en Y) procedure three months ago to

assist her in managing her weight. She is being seen in clinic for her routine 3 month post-operative

visit.

Patient had presented for an initial consult to discuss the possibility of weight loss surgery ~ 4 months

prior to her gastric bypass. At that time her past medical history was reviewed and included the

following diagnoses: morbid obesity, hypothyroidism and hypertension. Medications included:

Levothyroxine – 50 mcg/day, and Carvedilol – 1.75 mcg/day. Patient’s anthropometric

measurements were as follows: Ht. = 5’8”, Wt. = 277 lbs., BMI = 42, Body Fat% = 44. Vitals: blood

pressure = 142/96

Patient’s anthropometric measurements at her 3 month post-operative visit are as follows: Ht = 5’8’,

Wt. = 197 lbs., BMI = 30, Body Fat % = 33. Total weight loss since her initial consultation = 80 lbs.

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Vitals: blood pressure = 124/80 Patient reports that she is still taking her Levothyroxine – 50

mcg/day, however, is no longer taking any blood pressure medication.

Patient reports that she is unable to tolerate “normal diet”. She has begun to consuming a “soft diet”

– however, does report intolerance to chicken and some red meats with occasional nausea and

vomiting when she consumes them. She continues to report early satiety with most meals

measuring from two tablespoon to a maximum of half cup volume. Patient states that she is

currently consuming 3 meals/day. However, the frequency of meals may not be sufficient

Patient does report some additional concerns during our visit – she complains of hair thinning/loss

and at times fatigue. She is concerned about possible nutritional deficiencies. Patient is due to have

her 3 month nutritional labs completed; however, she has not gotten them drawn yet at this time.

Patient also reports that she has not had her thyroid levels checked since her surgery.

Nutrition Diagnostic Statement

Patient is concerned about menu planning to meet dietary needs. Also, need to address long-term

implications of micronutrient deficiencies

Nutrition Care Questions

As a dietitian/nutritionist working closely with Holly, address the following questions:

1. Patients considering bariatric surgical procedures may have several surgical options including the

procedure that Holly underwent. Using a table format, including Roux-en Y procedure, discuss 2-3

other procedures that may be considered and briefly state the pros and cons associated with each

one.

2. In addition to her planned meals, what would you recommend for her to do to meet the DRI for

the micronutrients? Please provide specific and detailed information regarding these

recommendations.

3. On the basis of the type of gastric bypass procedure that Holly has undergone, which

micronutrients would you consider are of the greatest concern in regards to deficiency? List 6

micronutrients of most concern (greatest to least) and possible clinical symptoms or condition

of concern from the deficiency?

4. Holly is complaining of hair thinning and loss as well as fatigue? Which three micronutrients could

be directly related to these issues? What are major dietary sources of these nutrients?

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5. As Holly continues to take the hypothyroid medication listed above, A) which other medical

conditions would be of concern or risk after bariatric surgery? B) What are three non-diet related

lifestyle changes that you would recommend to her

6. For Holly to slowly adjust to her new eating pattern with more frequent smaller meals and

snacks, provide her with a detailed one day menu with information on number of meals and

snack frequency, as well as, types of foods and beverages consumed? A). USING A TABLE

FORMAT, create a one day diet plan with details of each meal/snack, specific foods/beverages

and the amounts during those meals/snacks. BE AS SPECIFIC ABOUT THE FOODS/BEVERAGES.

B). Below the diet plan table, please give an estimated range of total kcalories per day for Holly.

C). Provide an estimate of the amount of water Holly should consume during one day