Running head: CASE STUDY 10

Lesson 10 Case Study

Determine Basic Concepts of Medical Nutrition Therapy
Angela Martin
United States University

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Lesson 10 Case Study- Jose

Introduction
This case analysis is about Jose who is a patient in the Beach Front Subacute Center. He
has a diagnosis of renal cell cancer that may have spread to other parts of his body. His doctors
removed one kidney and a large tumor. The other kidney appears healthy. Jose is recovering
from surgery at the subacute center. He will start chemotherapy once he is strong enough.
1. Review Jose's medical profile. List 5 nutrition related health problems. Explain your
answers.
First of all since Jose underwent a critical surgery so has lost 32 pounds. This is normal
as people do lose weight after surgery and Joses weight is still in normal range considering his
height and age. 5 nutrition related health problems are: high fasting blood glucose due to which
he needs to restrict his sugar intake; high Creatinine indicating that Jose should limit his protein
intake; low hemoglobin level due to iron deficiencies; low hermatocrit level due to iron
deficiency as Jose might have lost blood during surgery; and low albumin due to kidney not
working well.
2. How much weight has Jose lost? What is his percentage of Ideal Body Weight?
According to the information presented in the case study, Jose was weighing 204 pounds
initially and now after surgery he is at 172 pounds, indicating a weight loss of 32 pounds. The
Percentage Ideal Body Weight can be calculated by taking a ratio of actual weight and Ideal body
weight (Fulgoni, 2008).
Percentage of Ideal Body Weight = Original Weight/ Ideal Weight * 100
Percentage of Ideal Body Weight = 172 pounds / 179 kg *100
Percentage of Ideal Body Weight = 96%
3. Calculate Jose's BEE using the Harris-Benedict equation. Use his current weight.
BEE = 66.5+ (13.75 weight) + (5.003 height) (6.775 age)
BEE = 1885

CASE STUDY 10

4. Jose is out of bed and recovering from major surgery. Calculate his Total Daily
Expenditure (TDE).
Total Daily Expenditure measures the number of calories a person burns on daily basis.
The value of Total Daily Expenditure is calculated by scaling the Basal Metabolic Rate of a
person to his/her level of activity. The value of Total Daily Expenditure is important in creating a
nutrition plan for a person. The value of Total Daily Expenditure is dependent on BMR of a
person and their activity factor. Total Daily Expenditure of Jose is as follow:
Total Daily Expenditure = BMR x Activity Factor
Total Daily Expenditure =1885 * 1.2
Total Daily Expenditure = 2262
5. Jose is not eating. He is depressed about his illness. He tells you the food tastes bitter. As
the Certified Dietary Manager what can you do to help Jose improve his nutritional
status?
First of all as a dietary manager, I will give proper counseling to Jose based on the risks
associated with high blood sugar and malnutrition. Jose should be adequately motivated by
involving his family in his intervention. Whenever Jose takes good amount of food intake, he
should be appreciated so that through positive reinforcement he can be motivated to increase his
food intake. Jose will be given adequate opportunities to discuss his fear and apprehensions
about his disease that are making him depress and he will be given hope that if he adheres to his
nutrition plan and eat well, he will overcome his health concerns (Rollnick, Butler, Kinnersley,
Gregory & Mash, 2010).
6. Jose will eat hot cereal, juice and coffee for breakfast. Give 2 ways you could increase
calories in his mid-day meal and 2 ways you could increase protein in his breakfast meal.
Since Jose is having hot cereal, juice and coffee for breakfast, 2 ways by which we can
increase protein in his breakfast meal is by serving him 1 Cup Green Beans or Boiled Eggs. On

CASE STUDY 10
the other hand, 2 ways by which we can increase calories in his mid-day meal are by offering
him baked chicken (220 Kcal) or Homemade Chicken Fried Steak (498 Kcal).

Running head: CASE STUDY 10

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References

Rollnick, S., Butler, C. C., Kinnersley, P., Gregory, J., & Mash, B. (2010). Motivational
interviewing. BMJ, 340.
Fulgoni, V. L. (2008). Current protein intake in America: analysis of the National Health and
Nutrition Examination Survey, 20032004. The American journal of clinical
nutrition, 87(5), 1554S-1557S.