Question

James Roberts, a 72-year-old African American male, is admitted to University Hospital with dehydration and acute respiratory failure. Mr. Roberts’ past medical history includes hypertension and chronic obstructive pulmonary disease (COPD). His current medications include clonidine (anti-hypertensive), prednisone (corticosteroid), and albuterol (bronchodilator).

Since the death of his wife one year ago, Mr. Roberts lives alone and does not cook for himself. Per patient’s daughter, Mr. Roberts receives home-delivered meals from the food assistance program, Meals on Wheels. In addition to the one meal per day from Meals on Wheels, he relies on ready-to-eat foods, such as cereal, toast, canned fruit, cheese, processed deli meats (e.g. bologna), and snacks, such as potato chips and cookies. Due to ill-fitting dentures, Mr. Roberts does not eat fresh fruits and vegetables or unprocessed meats often.

Mr. Roberts has been placed on a mechanical ventilator due to his respiratory failure. Dr. Connors, the physician, wants to start nutrition support in the next 24 hours. As his nurse, you listen for bowel sounds and they are positive in all four quadrants of the abdomen.

The following information was recorded on admission:

Height: 5’10”                Weight: 155 lbs                      Usual weight (3 months ago): 170 lbs

Based on Mr. Roberts’ history, list two factors that place him at nutritional risk, and explain how each factor increases his risk of malnutrition. Calculate Mr. Roberts’ ideal body weight (IBW). Assume that Mr. Roberts has a medium frame.

Answer 1

1. Two factors that place Mr. Roberts at nutritional risk are:

a. Due to ill-fitting dentures, Mr. Roberts does not eat fresh fruits and vegetables or unprocessed meats often. Lack of fresh fruits and vegetables in a person's diet is always a reason to worry as he does not get all the essential nutrients, and thus it increases the risk of malnutrition.

b. He lives alone and does not cook for himself. He relies on 'Meals on Wheels' for once a day meal. In addition to the one meal per day from 'Meals on Wheels,' he relies on ready-to-eat foods, such as cereal, toast, canned fruit, cheese, processed deli meats (e.g. bologna), and snacks, such as potato chips and cookies. All these except the once a day 'Meals on Wheels' food are of nutritionally low value. The nutrition content of the food cannot be considered to be the required amount. This increases the risk of malnutrition.

2. Calculation of Mr. Roberts’ ideal body weight (IBW)

Ideal body weight (IBW) =  50 kg + 2.3 kg for each inch over 5 feet.

Height = 5' 10"

Ideal body weight (IBW) = 50 kg + 2.3 * 10 = 50 +23 = 73 kg