BASTYR CENTER FOR NATURAL HEALTH

Nutrition Team Care

Client Initials: A.G.

Date of Consult: 2/4/2013

ASSESSMENT
Client History:
28 year old Hispanic male comes in today seeking advice on improving his diet to support his health. Client is single and
lives alone in his own home with no children. Client injured back 1 year ago, which lead to excessive use of ibuprofen that
lead to gastritis and diagnosis of bleeding ulcer 6 months ago. Client is college educated with sedentary occupation as an
architect in a busy office setting. Client notes he works in stressful environment and 60 hours/week. Client is financially
secure and has means to purchase needed foods and supplements.

Food and Nutrition-Related History:

Client is a self-described flexitarian, eating meat once per week. Reports no food allergies, intolerances, or significant
dislikes/preferences. Client saw nutritionist 3 years ago because of weight gain. Client is proud of 25 lb weight loss 3 years
ago. During 25 lb weight loss period client cut out meat, soda and junk food. 24 hour recall reveals excessive consumption of
high fat dairy products and consumption of only non-heme iron sources. Primary care physician prescribed 10 mg iron pill
twice/day. Client has stomach discomfort when taking iron pills on empty stomach, so he consumes 1 pill in morning with
milk and another pill in the evening with ice cream. Consumes 2 beers on Sundays. Cross-trains (weight lifting, running,
cycling) about 60-75 minutes/d, 6 days/wk. Client is food secure.

Anthropometric Measures:
Height: 180.3 cm
Weight: 80.9 kg
BMI: 24.9 (Normal: 18.524.9)
IBW: 78kg 10% (71.4kg 87.3 kg); %IBW = 104%
11.3kg weight loss 3 years ago

Biochemical Data, Medical Tests, and Procedures:

Ferritin: 60 ng/mL WNL - low end
Hgb: 14 g/dL WNL
Hct: 41%
MCV: 82 fl WNL
MCH: 28 pg/cell - WNL
MCHC: 31 g/dL

Nutrition-Focused Physical Exam Findings:

Blood pressure: 118/67 mm Hg. Client was relaxed and engaged during examination and asked questions and clarifications
with suggestions.

TR5320 Teaching Materials

DIAGNOSIS
PES #1: NI 5.10.1.3 Inadequate Mineral Intake Iron related to low bioavailability of dietary iron and limited consumption of
iron rich foods as evidenced by Hct and MCHC values. Transferrin WNL (60ng/mL) but on the low end of the reference
range (12-300 ng/mL). Iron intake of only 7 mg/d of non-heme iron.
PES #2: NC 2.3 Food-medication interaction (dairy products-Ca, Fe supplement) related to knowledge deficit of decreased
iron absorption with concurrent intake of calcium as evidenced by 24 hour recall reveals consumption of dairy products with
iron supplements, Hct and MCHC values, transferrin WNL (60ng/mL) but on the low end of the reference range (12-300
ng/mL).

INTERVENTION
Nutrition Prescription:
General diet, 8 mg/day of Fe heme sources or 24 mg/day of non-heme Fe, consume non-dairy products high in vitamin C
with iron supplements.
Intervention #1: Nutrition Education Content Purpose (E-1.1):
Explained to patient that his iron status is low and concerns about potential iron deficiency complications. Provided client
with information of heme vs. non-heme sources of iron and explained differences in bioavailability. Provided a list of foods
high in heme and non-heme iron.
Intervention #2: Nutrition Education Content Priority modifications (E-1.2):
Provided client with information about calcium effects on decreased iron absorption. Provided client with information of
vitamin C and increased iron absorption. Provided client with list of foods high in vitamin C to consume with iron
supplementation to increase absorption.

MONITORING/EVALUATION
Professional Goal #1:
Improve clients iron stores by incorporating heme sources of iron into diet. Client will track consumption of iron and show
he is consuming 8 mg/day of heme sources of iron with a 3-day food record. At the end of todays session client will
demonstrate knowledge of differences in absorption of heme vs non-heme iron sources. Client will also demonstrate that he
is consuming 8mg/day of heme sources with 3-day food record at the next follow up appointment.
Professional Goal #2:
Improve iron stores by increasing absorption of iron. Client will track his diet with a 3-day food record to demonstrate that
he is not consuming dairy foods with iron supplements. At the end of todays session, client will be able to demonstrate
knowledge of calcium and iron absorption interactions. Client will also demonstrate knowledge of vitamin C and iron
absorption interactions.
Follow up in 2 weeks. Follow up activities:
Check clients food diary to assess how he is progressing with consuming heme and non-heme iron sources. Check that he is
consuming non-dairy sources and preferably choosing foods high in vitamin C when consuming with iron supplements.

Clinician Signature (electronic): Jason Park

Date: 2/4/2013

TR5320 Teaching Materials