Case Study Congestive Heart Failure

Congestive Heart Failure: Nutrition Assessment

Dr. Maxwell is a patient that has been admitted due to collapsing at home. Looking at this patient’s past medical history, we can see that he has a very complicated record. In order to further help Dr. Maxwell a full nutrition assessment needs to be done. To start, the dietitian needs to look at the anthropometrics of the patient. Dr. Maxwell is 5’10” with a weight of 165 pounds. After calculation, we can conclude that Dr. Maxwell’s BMI is 24 which falls in the “normal” range.1 In order to obtain this, we use the “Body Mass Index.”2 Aside from figuring out Dr. Maxwell’s BMI, it is also important to understand where Dr. Maxwell should be in terms of his weight. In order to determine this, we turn to “the Hamwi equation”.2 Upon calculation, we discover that Dr. Maxwell is ninety-nine percent of his ideal body weight which is 166 pounds. Finding the percentage ideal body weight was

Maxwell’s sodium appears to be lower than normal on his charts. For example, the reference range on his chart is between 136 to 145 mEq/L and on the first day of his stay Dr. Maxwell presented a sodium level of 132 mEq/L. This occurrence is easily summed up by understanding that insignificant portions of “sodium” and much more significant portions of “water” cause an problems such as this within the body .2 In Dr. Maxwell’s case we can see in his I/O chart that he is being given a high amount of fluids through his I.V. with little output. It is also important to note that Dr. Maxwell reported eating a low salt diet. Knowing that Dr. Maxwell came into the hospital consuming little salt, and that he is outputting a small amount of the fluid he is taking in, it makes sense to see his sodium levels to be on the lower side. Also, Dr. Maxwell has ascites and edema meaning that he is retaining fluids. As expected there are nutritional implications from this. For example, the transition from homeostasis to imbalance of “osmolality.”