Nutrition care process- A case study

1. NUTRITION CARE PROCESS- CASE STUDY
BENIGN PROSTATIC HYPERPLASIA (BPH)
TEHREEM
MSC. (HONS.) HUMAN
NUTRITION AND DIETETICS

2. PATIENT OVERVIEW/BACKGROUND
 55 Year old male
 Lives in Kuwait
 Current Medical History
 Benign Prostatic Hyperplasia
 Nephrolithiasis
 Food Allergy
 Past Medical History
 2 Submucous Resection (SMR) surgery to remove excess
tissue from enlarged turbinates
 1 Tonsils removal surgery
 Allergic Rhinitis
 Urinary Tract Infection
 Family history of allergies and diabetes

3. WHAT IS BENIGN PROSTATIC HYPERPLASIA?

4. THE PROSTATE GLAND
 The prostate is a small organ about the size of a
walnut. It lies below the bladder (where urine is
stored) and surrounds the urethra (the tube that
carries urine from the bladder). The prostate
makes a fluid that helps to nourish sperm as part
of the semen (ejaculatory fluid).

5. BENIGN PROSTATIC HYPERPLASIA
 Benign prostatic hyperplasia, or BPH, involves enlargement of the prostate
gland.
 The prostate enlargement in benign prostatic hyperplasia is not malignant
(not cancer).
 BPH can impede the flow of urine.
 Symptoms include frequent urge to urinate, getting up at night to urinate,
difficulty urinating and dribbling of urine.
 The treatment of benign prostatic hyperplasia is usually reserved for patients
with significant symptoms.
 Medical and surgical approaches are available to treat BPH.

6. RISK FACTORS/ PREVALANCE
 BPH is extremely common. Advanced age is a risk factor for an
enlarged prostate. Half of all men over 50 develop symptoms of
benign prostatic hyperplasia, but only 10% need medical or
surgical intervention.

7. MEDICAL DIAGNOSIS
 A doctor or other health care professional usually can detect an enlarged
prostate by rectal examination.
 The doctor also may examine the urethra, prostate, and bladder using a
cytoscope, an instrument that is inserted through the penis or with
ultrasound.
 A urologist is a specialist in diseases of the urinary system, including
diagnosing and treating problems of the prostate gland.

8. MEDICAL TREATMENT
Prostate surgery has traditionally been seen as offering the most benefits for BPH but unfortunately carries the
most risks.
Medical treatment of BPH is usually reserved for men who have significant symptoms. The available medications
include:
 Alpha blockers (tamsulosin (Flomax), alfuzosin (Uroxatral), and older medications such as terazosin (Hytrin),
slidosin (Rapaflo) or doxazosin (Cardura).
 5-alpha reductase inhibitors (Finasteride (Proscar) and dutasteride (Avodart).
Surgery or office procedures may also be used to treat BPH, most commonly in men who have not responded
satisfactorily to medicine or those who have more severe problems, such as a complete inability to urinate.
 Transurethral resection of the prostate (TURP)
 Laser procedures
 Microwave therapy

9. MEDICAL NUTRITION
THERAPY

10. GENERAL DIETARY GUIDELINES
 3 Meals 2-3 Snacks Per Day
 Vitamin Supplementation. (Vitamin E & Vitamin B6)
 Low Fat Diet Encourage Variety of Whole Grains, Legumes, Nuts, Fruits And Vegetables.
 Counseling To Provide Ideas For Calorie Boosters.
 Adequate fluid intake.

11. NUTRITION ASSESSMENT

12. PATIENT ANTHROPOMETRIC MEASUREMENTS
LAB VALUE
Height 5’6”
Weight 78
BMI 27.8 (overweight)
IBW 64.7
Waist Circumference 37”
Blood Pressure 138/84

13. CLINICAL SIGNS
 Rough and Dry skin
 Thin hair; Easily plucked out

14. PATIENT MEDICATIONS
MEDICATION REASON
Avodart prevents the conversion of testosterone to dihydrotestosterone (DHT) in the
body.
Pantomax Used for gastric ulcer and other conditions; reduces the amount of acid
produced in the stomach
Tamsulosin relaxes the muscles in the prostate and bladder neck, used to improve
urination in men.
Xopra Used for treatment of gastric/duodenal ulcer
Telefast used to relieve the symptoms of hayfever (seasonal allergic rhinitis) such as
sneezing, itchy, watery or red eye.
Xynosine Used to treat runny nose and nose stuffiness.
Combivair Used to treat asthma
Urixin Used to relieve and treat symptoms of urinary tract infections

15. NUTRITION REQUIREMENTS
Estimated Energy Needs 2250 kcal/day
Estimated Protein Needs 112.5 g/day
Estimated Carbohydrate Needs 281.25 g/day
Estimated Fat Needs 50 g/day
BMR/BEE 1618
Energy requirement calculated by Harris-Benedict Formula (MBR(BEE) x Multiplication Factor:

16. READINESS ASSESSMENT
 Willing to Modify Diet
 Take Nutritional Supplements each day
 Willing to Modify lifestyle

17. LIFESTYLE
Activity Intensity Days per week Duration
Stretching/Yoga - - -
Cardio/Aerobics (Walking,
jogging, biking)
moderate 4 days 15 minutes
Strength Training
(weightlifting, pilates)
- - -
Sports or leisure low - -
Others - - -
• Used to play sports such as football in the past but not anymore.
• Health and work limits from being physically active
• Work and health are the daily stressors
• On average, gets 8 hours of sleep in weekdays and 9 hours of sleep in weekends
• Never smoked, never drank alcohol and drugs.

18. DIGESTIVE HISTORY
Heartburn Sometimes
Gas Often
Bloating Often
Stomach Pain Sometimes
Nausea/ Vomiting Rarely
Diarrhea Rarely
Constipation Often
• Experiences gas and bloating while eating cauliflower, potato and rice.
• Has bowel movement 1 times per day

19. DIET HISTORY
 Limited diet due to health reasons.
 Has wheat, rice, egg and milk allergy
 Shops, eats and rely on mostly convenience and restaurant foods since
lives alone
 From FFQ:
 Bottled water: 4 glass per day
 Milk Tea: 2-3 cups per day
 Eats Less and no home-cooked meals; eats restaurant foods mostly.
 Less vegetable and fruits intake.
 Eating Style: fast eater, love to eat, eat too much, confused about food
and nutrition, poor snack choices, travel frequently, dislikes healthy food
and relies on convenience items

20. 24 HOUR RECALL
Meal Time Contents Exchange
Breakfast 9:00-9:20 am ½ C Daal Mash
1 chapati
1C Tea with Milk
• CHO
• Dairy
• Fat
Mid-day Snack 11:30-11:50 am 2 Guava • Vitamins/Miner
als
Lunch 2:00-2:30 pm ½C Chicken Karahi
2 chapatti
Raw Salad
• Protein
• CHO
• Fat
Evening Snack 5:30 pm 3 biscuits
1C Tea with Milk
• CHO
• Dairy
Dinner 8:30-9:00 pm ½C Daal Mash
2 Chapati
Green chutney
• CHO
• Dairy
• Fat
Bedtime Snack - - -

21. BIOCHEMICAL FINDINGS
Test Results Reference Range
Cholesterol 210mg/dL <200: Desirable
200-240: Borderline
>240: High risk
CHOL/HDL Ratio 5.8 0.0-4.5
LDL Cholesterol 158mg/dL <130 Desirable
130-190: Borderline
>190: High Risk
HDL Cholesterol 36mg/dL >45: Desirable
35-45: Borderline
<35: High Risk
25(OH)- Vitamin D3 15.64ng/mL <10: Deficiency
10-30: Insufficiency
30-100: Sufficiency
PSA Total 3.05ng/mL 0-4: Normal
4.1-10.0: Borderline

22. NUTRITION DIAGNOSIS

23. NUTRITION DIAGNOSIS
 Excessive energy intake related to limited access to healthful food choices as evidenced by BMI and
frequent restaurant eating.
 Inadequate Fiber and micronutrients related to limited diet as evidenced by occasional constipation and
thinning hair.
 High fat intake related to taste preferences for fried food as evidenced by diet history and borderline
cholesterol.
 Inadequate Vitamin D and Calcium intake related to low sun exposure as evidenced by Vitamin D
insufficiency
 Food and Nutrition knowledge deficit related to no previous dietetic education/consultation as
evidenced by patient unable to identify food with allergens

24. NUTRITION INTERVENTION

25. NUTRITIONAL INTERVENTION
 Goals: Patient to maintain or lose weight.
 Encourage fiber intake, monitor with labs
 Encourage adequate whole grain, vegetables and fruits intake
 Foods with allergens (wheat, rice, milk, egg, mutton, beef, peanuts, soya, orange) to be eaten on
alternate days.
 Portion size control
 To limit fat intake
 Identify and Avoid foods that cause digestive problems.

26. RECOMMENDATIONS
 Calorie Requirements: 1750-2000 kcal
 Fluid Requirements: 8-10 glasses
 Preferred Feeding Route: Oral
 Mechanism of diet: Regular Adequate diet
 Type of Diet: High fiber and low fat diet
 Exercise: Spend at least 30 minutes in physical activity such as walking 2-3 times per day. Have frequent
exposure to sunlight.

27. Timings Mon Tue Wed Thurs Fri Sat Sun
Pre-Breakfast
(7:30-8:00)
Figs
Water
Water with lemon Dried raisins
Water
Water with honey
and lemon
Dried Cranberries
Water
Water Water with lemon
Breakfast
(8:30-9:00)
Apple
Boiled Egg
Chapati/bran
bread
Tea with milk
Guava
Barley Cereal/
Porridge
Goat Milk
Banana
Cake Rusk
Tea
Pear
Omelet
Chapati,bread
Coffee
Plum
Barley/corn
Porridge
Skim Milk
Apple
French Toast
Black Tea
Guava
Chickpea curry
Chapati
Tea with milk
Mid-morning
(11:00-11:30)
Seasonal Fruit Digestive biscuits Veg Sandwich Oat Honey
Crackers
Weetabix Mixed dryfruits Seasonal Fruit
Lunch
(2:00-2:30)
Chicken curry
Green pepper
tomato
Chapati (wheat)
Yogurt/ Salad
Pulses
Steamed carrots
Rice
Yogurt/ Salad
Mutton
Mix Vegetables
Chapati (barley)
Yogurt/ Salad
Fish
Mashed potatoes
Chapati (wheat)
Yogurt/ Salad
Pulses
Vegetables
Brown Rice
Yogurt/ Salad
Chicken
Vegetables
Chapati (corn)
Yogurt/ Salad
Fish
Vegetables
Chapati (wheat)
Yogurt/ Salad
Mid-Afternoon
(4:30-5:00)
Veg Sandwich
Sunflower seeds
Tea
Oat Crackers
Fruit Juice
Baked Potato
Tea
Mixed dryfruits
Apple shake
Chickpea salad
Tea
Veg cutlets
Green Tea
Salted Crackers
Kashmiri Tea
Dinner
(8:30-9:00)
Banana
Veg Soup
Chicken
Chapati (wheat)
Salad
Pea Soup
Meat
Chapati (barley)
Cake Slice
Orange
Garlic bread
Mutton
Chapati (corn)
yogurt
Mushroom Soup
Chicken
Chapati (wheat)
Salad
Kheer
Guava
Veg cutlets
Daal Mash
Chapati (barley)
Salad
Soup
Chicken
Vegetables/pulses
Chapati (corn)
Salad
Banana
Soup
Beef (lean)
vegetables
Chapati (wheat)
Salad
Bed Time
(10:00-10:15)
Herbal/ Green Tea Skim Milk Jasmine tea Skim milk with
honey
Ginger Tea Figs Skim milk with
turmeric and
honey
DIET PLAN

28. NUTRITION MONITORING
& EVALUATION

29. NUTRITION MONITORING
 Monitor weight
 Monitor Lab values
 Monitor symptoms and nutrient intake
 Supplement: Multi-vitamin and Vitamin D supplement
 Follow up: Follow up in 7 days

30. NUTRITION EVALUATION
Follow-up Assessment
 Patient has increased fiber and fruits intake, controls portion size.
 Pt. has limited his fat intake, avoids fried food.
 Patient reports less digestive symptoms (constipation)
 Urination without discomfort.
 Feels more active