MNT pt1

Brittany Brockner
Marywood University
NCP Project
List of interview question

Client History
1. Are you using any supplements, medications? If so what kind and how often?
-medication= synthroid (a hormone replacement when you dont have a thyroid) taken 1x
day
-Supplement= multivitamin, vitamin b1 (1000mg) , vitamin d(2,000mg). all taken 1x day
2. What is your family medical history?
-has no tonsils, has had thyroid cancer at 40 and had it removed, has IBS
3. Any weight loss/gain in the past month?
-no
4. Any chronic pain?
-stomach
5. What is your medical history
- thyroid cancer, IBS
Food/Nutrition history
1. What are your food intolerances/ sensitivities?
-gluten sensitivity, lactose intolerance
2. Who buys food in your household?
- she does
3. Do you have food readily available in your home?
-yes
4. How much physical activity do you do a week?
- high intensity 1 hour per day and 1 hour of moderate intensity 6 days a week
5. What are your attitudes towards food?
6. Are there any foods that you prefer to avoid?
- doesnt eat burned food.
7. Take 24 hour recall
Breakfast- 1 banna, 1 apple cinnamon rice cake with peter pan peanut butter
-water
-coffee with milk, 2tsp sugar
Lunch- sandwich with cheddar cheese and roast beef on a gluten free bagel
With herbal tea
Snack- gluten free kind pecan chocolate energy bar. 10 almonds whole natural
Dinner- spaghetti with tomatoes sauce and meatballs
Salad with lettuce, olives, cooked beats with lemon oil and salt
Snack- apple
Anthropometric measurements
1. What is your height?
- 55
2. Weight?
- 110
3. Age?
50
4. Waist circumference
26
5. BMI= (50)/ (1.6)^2= 19.5
Biochemical data
1. Get laboratory test, blood lipid profile, lab tests, electrolytes
Nutrition focused physical examination examined the following
1. thickness of hair
2. overall vitality
3. skin color
4. oral health
5. muscle, shoulders
6. subcutaneous fat
7. temples
Nutritional risk
Through nutrition screening I was able to determine nutritional risk for my client. By
obtaining, verifying, and interpreting subjective information from the interview and
objective data from the physical nutrition assessment and lab data, I determined my client
is at medium nutritional risk. To determine this score, I used a combination of screening
tools. Two tools were used from the Pocket Guide to Nutrition Assessment, figure 2.1
determined my client was at a risk for malnutrition and figure 2.5 determined my client
had a score of 1, which indicates medium risk. In addition to the pocket guide, I also took
into account my clients chronic stomach pain and abnormally low serum thyroglobulin
levels to determine medium nutritional risk.
Assessment of Interview Questions
In preparation for the interview I included questions from each of the nutrition
assessment domains to make sure I obtained all the relevant information needed. I obtain
a lot of valuable information, however I wish I had asked additional questions regarding
my clients medical history. I found out she has had her thyroid removed because of
thyroid cancer 10 years ago, but I did not ask how long she has thyroid cancer for before
she had it removed. I also wish that I were about obtain more biochemical data from the
client. In addition, obtaining more information in my clients everyday food consumption
in addition to the 24 hour recall would have been beneficial.
Calculated Clients Nutrient Needs
Estimated Energy Requirements:

RMR= 9.99 * 50kg + 6.25 * 165cm 4.92* 50yr 161
TER= 1.724 (very active)
Energy requirement= 1,123.75 * 1.725= 1,938kcals
I used the diet analysis energy intake recommendation of 2124kcals instead of my own
calculated energy intake because I think it is more appropriate to continue the amount of
calories my client is currently taking in instead of reducing the amount to 1,938kcals
since my client is already thin and does not wish to loose any weight. Although a
thyroidectomy typically caused a reduction in metabolic rate and causes the client to not
burn as many calories, contributing to weight gain, my client has not experienced any
weight gain. Instead my client has experience a 10lb weight loss in the past 10 years. Her
gradual weight loss, and high activity level contribute to the higher energy intake.
Individualized RDA for protein:
50kg * 1.5g/kg=75g
I used the upper protein end of 1.5g/kg of my clients high activity level and metabolic
stress caused from post thyroidectomy and IBS.
Daily Fluid Needs:
(100mg*10kg) + (50mg*10kg) + (20ml*30kg)= 2,100ml
I used two different equations to calculate fluid needs, fluid needs based on age and based
on weight. I used fluid needs based on weight because that equation yields a higher
amount of water, which is beneficial for my client with IBS.
Weight Change
Client has expressed no weight change is desired
Adequacy of 24 hour recall
According to the 24-hour recall my client is consuming an adequate amount of calories
per day. Protein intake however is excessive going over 44g of the DRI and about 10
grams over my calculated needs. Carbohydrate intake is low, consuming about 230g per
day. An increase in carbohydrate intake could benefit my client. Fat intake is excessive.
Specifically, saturated fat intake is excessive. This is reflected in the 24-hour recall as
well as the biochemical data as elevated hemoglobin a1c levels are associated with high
saturated fat intake. Post thyroidectomy, calcium and vitamin D levels may fall below
normal both temporarily and even long term. My clients vitamin D intake is extremely
low, however she is taking a vitamin D supplement that can fulfill the daily vitamin D
intake requirement. Calcium should also be increased in the diet because the 24-hour
recall consumption is 63% of the DRI.
Assessment of Clients Diet Order
The DRI for thiamin is 1.1mg/day and my client is taking a thiamine supplement once a
day of 1000mg. Client is also taking a vitamin D supplement of 2,000mg each day. This
amount is above the RDA but below the upper limit for vitamin D which is 4,000mg.
However I would increase the vitamin D food sources in the diet and decrease the
frequency of the supplement intake. My clients iron intake is low. In addition, the
biochemical data shows slightly elevated hemoglobin a1c levels which can indicate iron
deficiency. IBS can also contribute to a malabsorption of iron. I would increase the
amount of iron my client is consuming. In consideration for irritable bowel syndrome
with constipation, fiber should be about 20- 30g, which is currently met according to the
24 hour recall. I would keep fiber intake as is. Increasing fiber could exacerbate stomach
pain. In addition, water intake should be also be an emphasis to ease my clients chronic
pain. To reduce pain and bloating client avoids fried foods.

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Brittany Brockner

List of interview question

Estimated Energy Requirements:

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