Also need to interpret and evaluate the differences between ada, cns


Using a provided case study including intake form, case history, blood chemistry, anthropometric measurement the student needs to write up a Report of Findings to a Medical Professional for a case that requires additional testing in a certain area and/or case is above the scope of practice for the nutritional professional thus needs to refer out.

•Student needs to show the proficiency in utilizing ADIME (Assessment, Diagnosis, Intervention, Monitoring, and Evaluation) principles to assess case and determine why it needs to be referedout

Read the entire case study below, this case study is very complicated but a very real life potential future client. Once you have read this case, analyzed it through the blood chemistry and symptoms come up with all the nutritional associated diagnosis by using the links and references on previous page.

Case Study- AV

AV is a 67 year old female. She had breast cancer 10 years ago and the chemotherapy and radiation damaged her liver. She is supposed to have a liver transplant but is not very high on the list of transplants because of her age and the fact that her liver seems to “hold up” as her doctors are saying. AV is severely jaundiced on appearance; she is also suffering from severe edema in her ankles. She is suffering from severe fatigue, RA, migraines, osteopenia, GERD, hypothyroid. By looking at her you can see eczema, hirsutism, soft brittle nails, skin tags, and acanthosis nigricans. She is desperate for some help, she realizes you might not be able to assist her, but nobody seems to care about her health, she feels it is almost like she is being pushed aside due to her age. She has grand kids and wants to see if she can maybe get healthier and extend her life a little. She is very depressed and teary eyed when she is providing you with this information.

Initial Assessment:

B/P: 145/85

Height: 5.4”

Weight: 235 lb

BMI: 36

Fat%: 56%


As explained above all of her health issues started with the chemotherapy and radiation. Before this she was a healthy 140 lbs female, she played sports and was an active teacher. She had suffered from cysts for many years until the diagnosis of cancer. She has had multiple yeast infections over her lifetime. She was told she might be “non-celiac gluten sensitive so she has incorporated a gluten free lifestyle. She feels full very quickly. She suffers from depression and is on medication

Medication and Supplements:

Lotensin (ACE inhibitor)- 40 mg once daily

Prevacid (proton pump inhibitor)- 30 mg once daily

Metformin- 500 mg twice daily

Effexor (SSRI)- 150 mg daily

Furosemide (loop diuretic)- 40 mg twice daily

Laboratory Data:

Vitamin D 25 OH – 15.2 (L) (32 – 100 ng/mL)

Potassium – 5.7 (H) (3.5-5.0 mEq/L)

Sodium – 128 (L) (136-145 mEq/L)

Bun/Creatinine Ratio – 23 (H) (10-20)

Co2 – 19 (L) (23-30 mEq/L)

Albumin – 2.9 (L) (3.5-5 g/dL)

Total Bilirubin – 5.3 (H) (0.3-1.0 mg/dL)

ALP – 162 (H) (30-120 U/L)

ALT – 222 (H) (4-36 U/L)

AST –112 (H) (0-35 U/L)

RBC – 2.50 x 1012/L (L) (4.2-5.4 x 1012/L)

Platelets – 80,000 x 109/L (L) (150,000-400,000 x 109/L)

RDW – 21.1 (H) 11-14.5%

MCH – 40.5 (H) 27-31 pg

MCV – 122 (H) 80-95 fL

HCT – 30% (L) (37-47%)

Hgb – 10.4 g/dL(L) (12-16 g/dL)

LDL – 158 (H) (<130 mg/dL)

Triglycerides – 235 (H) (40-160 mg/dL)

TSH – 12 mU/L (H) (2-10 mU/L)

Thyroid peroxidase antibody (TPO-Ab) – 103 (H) (<35 IU/mL)

Fasting glucose – 117 (H) (70-110 mg/dL)

Dietary Intake:

Breakfast: Gluten free cereal and banana or scrambled eggs or gluten free pancakes – tea black

Snack: yogurt (low fat Greek) – water

Lunch: Salad with cottage cheese or soup (canned) with fruit or PB sandwich on gluten free bread – water

Snack: Fruit – water

Dinner: 4 ounces of beef/chicken/turkey, steamed broccoli or asparagus, small herb salad – tea black and water

Also need to Interpret and evaluate the differences between ADA, CNS and NANP – Scope of Practice document and write 2 pages on it

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