Ms. Swanson is a 92-year-old resident at Northern Oaks Nursing Center who is being admitted to the local hospital for dehydration and weight loss of 8 pounds in the past 2 weeks. Her medical history includes advanced dementia, a stroke 2 years ago that left her unable to feed herself, and high blood pressure. Her anthropometric measurements include: height 5 feet 2 inches, weight 91 pounds. Ms. Swanson's usual appetite is pretty good. She is on a ground/minced diet due to swallowing difficulties as a result of her stroke. Prior to hospital admission her appetite had declined significantly and she refused to drink most fluids offered to her during the day by nursing and dietary staff. At the hospital an IV is started to help correct her dehydration (which was confirmed via lab work). Her lab work also indicates her transthyretin is low (15 mg/dL). An inpatient dietitian is assigned to Ms. Swanson to help increase her kcalorie and protein intakes in addition to her overall food intake. 1. What is Ms. Swanson's desirable (or healthy) body weight? Discuss how you determined her desirable (or healthy) body weight.
2. What is her percent ideal body weight? (%IBW) (Show your calculations.)
3. What are some physical signs of dehydration that might be seen in a patient?
4. What does Ms. Swanson's low transthyretin indicate about her current state of health?
5. What suggestions do you have for increasing Ms. Swanson's kcalorie and protein intakes?
6. What suggestions do you have for increasing Ms. Swanson's overall food intake?

1. 45.9 to 62 kg.

2. 82.72 %

Explanation:

1. We have to find out Mr. Swanson's body weight by calculating his body mass index.

From body mass index or BMI = weight of the person in kg / height in meter

BMI = 41.36/ 1.5748

      = 41.36 /2.47999504

      = 16.67

The normal range of BMI is 18.5 to 24.9. So, Ms. Swanson's desirable body weight would be 45.9 to 62 kgs.

2. Mr. Swanson's  percent ideal body weight:

   =

 Now calculating the ideal body = 45.5 kg + 2.3 kg for each inch above 5 feet

Ideal body weight (IBW) = 45.5 + 2.3 x 2

                                        = 50 kg

Now calculating the percentage ideal body weight

   =

   = 0.8272 x 100

   = 82.72 %

The normal range of percentage ideal body weight lies between 90 - 100 percent. Thus, the percentage ideal body weight of Mr. Swanson is low.

3. Some of the physical signs that can be seen in the patient when the patient is dehydrated are :

 i). Dry skin

 ii). weight loss

 iii). thirsty

 iv). pale skin color

  v). fatigue

  vi). tiredness

   vii). dizziness

4. The transthyretin of Mr. Swanson is quite low and it indicates malnutrition. His transthyretin is about 15mg/dl. Thus he require proper diet planning and modifications.

5. Mr. Swanson must take in high calorie food and should consume plenty of water. She should also include fibers in her food intake. Mr. Swanson should consult a nutritionist or a dietitian who could properly guide her and make a food chart that includes daily intake of nutritious and protein rich food.

6. For increasing the food intake, Mr. Swanson must follow a healthy diet. He should take small servings but many times a day. Also exercising and drinking plenty of water will increase his food intake and will keep him healthy.

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