Advanced Nutrition Micronutrient Spring
NFS 4313 – Advanced Nutrition Micronutrient Spring 2021
Case Study Assignment 2 (60 points) Due Date – April 11th, 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
Juan is a 67 year old male with chronic kidney disease (CKD) stage 4 secondary to hypertension, which
was undiagnosed for many years since he had not had regular checks with a medical provider. Family
history includes father who died of stroke, and mother with type 2 diabetes currently on oral meds.
He was referred for Medical Nutrition Therapy by his nephrologist who has seen him twice so far.
The MNT service was approved for coverage based on Medicare guidelines.
Patient is married with 1 adult child and 2 grandchildren in the home. Wife prepares most meals,
traditional Mexican cuisine and he takes a prepared lunch when on the job as a construction worker. He
is struggling to complete his tasks at work due to fatigue. He has not noticed a change in appetite,
although some foods don’t taste as good. Although he has some missing teeth, he reports that this does
not affect his choice of foods or ability to eat. He does experience constipation more frequently. His diet
is low in fiber and he indicates that he is more inactive or sedentary now then what just a year ago.
Although he had not been accustomed to taking medications, his list now includes a diuretic, anti-
hypertensives, statin, and sodium bicarbonate. He says he was advised by his primary care physician to
decrease salt intake his diet but his wife has struggled to adjust her cooking to restrict use of salt.
Lab values 1/14/21:
Creatinine: 2.4 mg/dL Alb: 3.5 g/dl Chol: 210 mg/dl TG: 344 mg/dl
Potassium: 5.5 mEq/L CO2: 17 HDL: 33 LDL: 120
Calcium: 9.8 mg/dl Phos: 5.1 mg/dl HbA1c: 9.9% TSat: 19%
Glucose: 127 mg/dl (fasting) BUN: 72
Anthropometric measurements Measured Height, w/o shoes: 5’7”
Current Weight: 155 lb (weight loss over past yr from 182 lb usual wt.)
Fluid status: 2+ edema
Patient says he is adjusting to the idea of having chronic kidney disease, but is not sure he will want to
go on dialysis which is recommended. Wife is present with him for this session, and is able to speak
English. Patient’s English is adequate, but he cannot read English or Spanish.
Nutrition Diagnostic Statement
Patient and his family struggles to fully understand CKD and in planning to meet dietary needs. Also,
need to address long-term implications in regards to micronutrient needs.
Nutrition Care Questions
As a dietitian/nutritionist working closely with Juan, address the following questions:
1. Using lay language (non-scientific), describe in a short statement (4-5 sentences) what is CKD to Juan
and his family. WRITE THIS STATEMENT LIKE YOU ARE SPEAKING TO THE PATIENT AND FAMILY
2. A) From the lab values provided in the case scenario, calculate Juan’s glomerular filtration rate (GFR)
and write a sentence or two to justify the need for dialysis; B) Explain to the patient and family what
is dialysis and why it may be important to consider dialysis for Juan (BE SPECIFIC)
3. Which five micronutrients are of greatest concern in CKD? List each of these five nutrients in order of
importance (greatest to least) along with the specify condition(s) of deficiency or potential toxicity
concern that needs to be addressed. (USE A TABLE FORMAT FOR YOUR RESPONSE)
4. A) Does Juan need to take dietary supplements? If so, please specify brand, dosage, and which
micronutrients would be the most important; B) Explain the reasons why Juan requires use of
sodium bicarbonate supplements?
5. Considering his family history, medication use, and the most recent lab values, what are four
important points of advice that you would give to Juan in regards to (non dietary) lifestyle
modification that can improve outcomes for someone with CKD.
6. Juan’s wife is solely responsible for his dietary intake. He eats primarily traditional
Hispanic/Mexican foods prepared at home. A). Based on information provided about Juan,
calculated the daily estimated kcalorie requirement. Show what formula and your work used to
calculated this value. B). Considering his condition, what is the estimated amount of daily fluid/water
intake recommended for Juan. C). USING A TABLE FORMAT, PROVIDE A TWO DAY MENU OF MEALS
AND SNACKS. Provide a variety of foods across the two days and specify foods by meals and
amounts to assist Juan’s wife in meeting his dietary needs and restrictions. Use abbreviations as
shown to labels foods that would be naturally low in sodium (LS), prepared with sodium restriction
(SR), and good source of dietary fiber (DF). Energy value (kcalories) for each food item is not
required to be provided in this table.
