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Hepatitis C Case Study
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- 2. PATIENT DATA Age:26 Sex: Female Ethnicity: European American Height: 5’8’’ Weight: 125 lbs Diagnosed with Hepatitis C, 3 years ago Complaints: fatigue, anorexia, pale skin and weakness.
- 3. ASSESSMENT Food and nutritionrelated history: Had no appetite for the past few weeks Only juice, water, diet coke in the past 2 days About 1200 cal intake per day Lost 10# in 6 months Doesn’t like liver or lima beans 200 mg of milk thistle twice daily 3 grams chicory 500 mg ginger at least twice daily Daily multivitamin/mineral supplements Treated with Alpha-interferon and ribavirin
- 4. ASSESSMENT Anthropometric measurements: Height= 5’8’’ Weight = 125 lb Usual body weight = 135 lb BMI = 19 which is normal IBW% = 87.6% UBW% = 92.6%
- 5. BIOCHEMICAL DATA Chemistry RefRange BUN 8-18 21 ↑ Creatinine serum 0.6-1.2 1.4 ↑ Glucose 70.110 115 ↑ Bilirubin <0.3 3.7 ↑ Total Protein 6-8 5.4 ↓ Alkaline Phosphatase 30-120 275 ↑ ALT 4-36 62 ↑ AST 0-35 230 ↑ HDL >55 50 ↓ Triglycerides 35-135 256 ↑ PT 12.4-14.4 18.5 ↑
- 6. BIOCHEMICAL DATA Chemistry RefRange RBC 4.2-5.4 4.1 ↓ Hemoglobin 12-15 10.9 ↓ Hematocrit 37-47 35.9 ↓ Urinalysis Protein Neg 1+ ↑
- 7. LAB DATA INTERPRETATION High BUN: indicates kidney disease or dehydration High Creatinine: indicates kidney disease or dehydration as well Slightly high glucose: pre-diabetes High Bilirubin: confirms that the liver is the cause of jaundice Low total protein: caused from the liver disease, malnutrition and protein-loss enteropathy High Alkaline Phosphatase: suggests cholestasis High ALT and AST: increase with liver damage
- 8. LAB DATA INTERPRETATION High triglycerides: because of the decreased bile salts. And in Cirrhosis, the body prefers lipids for energy in the fasting state High PT: indicates vitamin K deficiency and decreased synthesis of clotting factors Low RBC, hemoglobin, and hematocrit: anemia Protein in urine: a sign of kidney disease Stool is light brown: Fat malabsorption
- 9. NUTRITION FOCUS PHYSICALFINDINGS Dry skin and mucus because of the dehydration Bruises because of the liver disease and vitamin K deficiency Weight loss due to loss of appetite Enlarged esophageal veins; hypertension Pale skin is a sign of anemia
- 10. BRUISING RELATED TOVITAMIN K DEFICIENCY
- 11. CLIENT HISTORY Thepatient was in a good health until 3 years ago when she was diagnosed with Hepatitis C. Mother(living) – HTN, diverticulitis, cholecystitis, carpal tunnel syndrome. Father(deceased) – diabetes mellitus, peptic ulcer disease. Maternal grandmother – cholecystitis, bilateral breast cancer. Maternal grandfather – leukemia Parental grandfather – cirrhosis Parental grandmother – amyotrophic lateral sclerosis
- 12. CLIENT HISTORY Theprevious nutrition therapy was 3 years ago: small, frequent meals, plenty of liquids. Previously treated with alpha-interferon and ribavirin. Seasonal allergies treated with antihistamines. Live with a roommate who is a law student.
- 13. SUBJECTIVE GLOBAL ASSESSMENT PARAMETERS History Weight changes Appetite Taste changes Dietary intake Persistent gastrointestinal problems Physical findings Muscle wasting Fat stores Edema
- 14. SUBJECTIVE GLOBAL ASSESSMENT PARAMETERS Existing conditions Other problems that could influence nutrition status Nutrition rating based on results Well nourished Moderately malnourished Severely malnourished
- 15. NUTRITION DIAGNOSIS Medicaldiagnosis: chronic Hepatitis C and recreantly, Cirrhosis. Pre-diabetes, weight loss, bruising, Vitamin K deficiency, and anorexia resulted from the disease Iron deficiency Anemia Inadequate intake related to decreased appetite as evidenced by and intake of 57% of the estimated energy requirements
- 16. INTERVENTION 24 hourrecall Sips of water, juice, and diet coke Usual intake Breakfast: Calcium fortified orange juice Lunch: soup and crackers with diet coke Dinner: carry-out Chinese or Italian food
- 17. INTERVENTION The goalis gradually increasing the caloric intake on a two weeks period till the EER is met. And to improve the anemia, vitamin K deficiency, and the hyperglycemia. Protein: 1.3 g/kg/day = 15% Fat: 40% Carbohydrates: 45% Water: at least 10 glasses per day Iron supplementation 200 mg milk thistle twice daily chicory 3 grams daily 500 mg ginger twice daily
- 18. THE CORRECTIVE SAMPLEMENU Breakfast Whole milk 1 cup oatmeal 1 package Banana 1 Whole wheat toast 1 slice Peanut butter 1 tbsp Snack Non-fat Greek yogurt
- 19. THE CORRECTIVE SAMPLEMENU Lunch Vegetables salad 1,5 cup Olive oil 1 tbsp Tilapia fillet 1 fillet Sauteed spinach 1 cup Brown rice 0.5 cup Snack Apple 1 Chopped cucumbers 1 cup
- 20. THE CORRECTIVE SAMPLEMENU Dinner Homemade vegetable soup 1 bowl Grilled chicken breast 1 slice Cannola oil 1 tbsp Shredded Parmesan cheese 2 tbsp Boiled Asparagus 1 cup Snack Orange juice 1 cup
- 21. COMPARISON Carbohydrates 43% Protein 17% Fat 40% Carbohydrates 57% Protein16% Fat 27% Corrective Menu 2100 cal Usual intake 900 cal
- 22. NUTRITION EDUCATION Healthyfood choices Macro and micro nutrients Nutritional impact on anemia The good fat sources Carbohydrate control for hypoglycemia Vitamin and mineral supplements importance Oral liquid and rehydration
- 23. NUTRITION COUNSELING Alwayseat breakfast Eat small, frequent meals Healthy snacks choices Use spices to increase the appetite Exercise Keep a food diary Avoid eating alone
- 24. MONITORING AND EVALUATION Weight Blood glucose Biochemical data Anemia Hydration Skin bruising Food diary
- 25. POSSIBLE MONITORING Adjunctivenutrition support should be given to malnourished patients if their intake is less than DRI levels of 0.8g of protein and 30 cal/kg per day. Esophageal varices are not a contraindication for tube feeding. Medium chain fatty acids and whole protein formulas are encouraged May contribute to 50% of the daily nutrient intake. Intravenous vitamin K for 3 days to rule out the deficiency.
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