Brigit ADIME Week 3

Assessment:
Brigit a 17 year old is brought in to the doctors after complaints of chronic fatigue,
tingling in her extremities, pale skin, and increasing appetite. Brigit runs track and plays
varsity volleyball, but has been noticing a poor performance lately and the inability to
concentrate in class. Brigit avoids eating meats, but does eat diary product. She
consumes a vegetarian diet, but does not know how to manage the diet. Brigit does not
have any nutrition prescribed interactions.
Anthropometrics:
Ht: 167.6cm (66)
BMI: 21.85kg/m2 (normal)
Wt.: 135lbs (61.4kg) IBW: 130bs (59kg)
%IBW: 104%
UBW: 135#
%UBW: 100%
TSF:10mm (10 percentile, below average)
AMA: 41.6cm2 (85-90th percentile, above average musculature)
MAC: 26cm
Biochemical:
Fe (serum) 31ug/dL (normal)
Hct 33% (low)
Hgb 9.5g/dL (low)
Ferritin 150ug/L (normal)
RBC 4.5 x 10^2 / L (normal)
MCV 94 x 10^(-15) (microcytic)

Transferrin 2.2g/L (low)

TIBC 475ug/dL (high)
MCV 73fL (low)
MCH 22pg/cell (low)
MCHC 28.8 (hypochromic)

Clinical:
Physical assessment not performed
Diet Hx per 24-hour recall:
3670kcal; 100g PRO (11% kcal, 1.63g/kg) 440.5g CHO (48% kcal) 135g FAT (33%kcal)
Pt consuming 704kcal/day in energy excess. Diet is low in iron-rich foods, low in whole
grain and fiber. Pt. has no known food allergies or intolerances. Pt. does not consume
vitamin supplements. Pt. follows a vegetarian diet but lacks the necessary knowledge to
maintain and stay healthy on it.
Exercise and &PA: Pt is on the track team and varsity volleyball team, therefore is
very active.
Nutrient needs using Harris Benedict equation x AF of 2.0
2966kcal, 90.2g PRO (12.2% kcal) 445g CHO (60% kcal) 92.3g FAT (28 kcal) Fluids:
67.5oz/per day.

Diagnosis:
1) Inadequate iron intake as related to iron-deficiency anemia as evidenced by lab
values.
2) Food Nutrition related knowledge deficit as related to inadequate iron intake as
evidenced by a vegetarian diet low in iron rich foods.
Intervention:
Goal (1): Increase intake of iron through food and supplements
Strategies to achieve goal: The RDA for iron intake for Brigit is 15mg/day. Pt.
should consume single vitamin iron supplements, along with foods high in vitamin C to
increase absorption. Pt should consume cereal fortified with iron with 100% of the DV
(18mg/serving), or a cup of white beans, which contain 8mg.
Goal (2): Educate pt. on eating healthy through a vegetarian diet
Strategies to achieve goal: Pt. to be educated on eating a balanced diet through a
vegetarian diet. Pt. will be educating regarding the nutrients that need extra attention such
as iron, calcium, vitamin B12, vitamin D, and protein. Pt. will be shown what foods to
buy to support a balanced diet, for example fruits, vegetables, legumes, nuts, seeds, and
whole grain products. Pt. will demonstrate understanding by performing a 24-hour diet
recall that shows a balanced diet.
Monitoring and Evaluation:
RD to reassess lab values within one month to see an increase in lab values such as (Hgb,
Hct, Fe, MCV, and MCH). An increase in lab values with demonstrated to RD that
patient is consuming more iron rich foods and has an understanding of a balanced diet.
RD will reassess pt.s complain of tingling in extremities, pale skin, chronic fatigue, and
inability to focus in class as a result of iron-deficiency anemia, as well as patients activity
level, motivation and any additional patient needs.
Vince Nguyen, RD in training
1/30/2016, 5pm
FSN 429 (12-3 Lab)

ADIME WEEK 3

Vince Nguyen
FSN 429-02
12-3pm
1/31/2016