Evaluate the patient’s admitting history and physical. Are there any signs or symptoms that support the diagnosis of anemia?

Case study questions

1.    Evaluate the patient’s admitting history and physical. Are there any signs or symptoms that support the diagnosis of anemia?

2.    What laboratory values or other tests support the diagnosis of megaloblastic macrocytic anemia? List all abnormal values and explain the likely cause for each abnormal value.

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3.    What hematological values normally change in pregnancy?

4.    Define the following types of anemia: megaloblastic anemia, pernicious anemia, normocytic anemia, microcytic anemia. Include nutrients the deficiency of which can cause or be caused (distinguish) by these anemias.

5.    Vitamin B12 and folate deficiencies are often difficult to distinguish from one another. Describe the interdependence of these two nutrients and how the deficiency of one may be related to the deficiency of the other.

6.    List the most common causes of folate and B12 deficienies.

7.    Explain why the following tests were included in the medical diagnostic work-up:
a.    anti-intrinsic factor antibodies

b.    anti-parietal cell antibodies

c.    methylmalonic acid

d.    homocysteine

8.    Discuss the specific nutritional requirements during pregnancy. Be sure to address all macro- and micronutrients that are altered during pregnancy.

9.    Assess Mrs. ABC’s height and weight. Calculate her BMI and % usual body weight

10.    Check Mrs. ABC’s prepregnancy weight. Plot her weight gain on the maternal weight gain curve (indicate your source). Is her weight gain adequate? How does her weight gain compare to the current recommendations?

11.    Determine Mrs. ABCs energy and protein requirements. Explain the rationale for the method you used to calculate these requirements.

12.    Using her 24-hr recall, compare her dietary intake with her requirements for energy, protein, folate, B12 and iron. Indicate the method you used for calculation.

13.    Write a PES statement for each nutrition problem.

14.    Mrs. ABC says she does not take her prenatal vitamin. What nutrient does this supplement provide?

15.    List factors that you would monitor to assess her pregnancy, nutritional and B12 status.

16.    Complete the ADIME sheet.

A – Assessment
S – Subjective
Chief Complaint:


Weight change: gain / loss


Chewing / swallowing problem / sore mouth

Nausea / vomiting / diarrhea / constipation

Food intolerance / allergies:

Diet prior to admit:    Nutritional supplement:

Vitamins / herbs:

Food  preparation:

Factors affecting food intake:

Social / cultural / religious / financial


O – Objective
Current Diet Order:

Medical Diagnosis:
Past Medical History:

Nutrition Focused Physical Signs & Symptoms:


Gender: Male      ?
Female  ?    Ht:    Wt:        Admit    ?
Current   ?    DBW:    BMI:
% UBW:

% wt ?:    % DBW:    Other:
Nutritionally Relevant Laboratory Data:

Drug Nutrient Interaction:

Estimated Energy Need:

______________ kcal / day
Based on:
Estimated Protein Need:

_______________  g/day
Based on:    Estimated Fluid Need:

_____________ ml / day
Based on:
Nutrition Diagnosis (D)
A – Assessment (A)
State no more than 2 priority Nutrition Diagnosis  statements in PES Format. Use Nutrition Diagnosis Terminology sheet
ND Term (Problem)  related to (Etiology) as evidenced by (Signs and Symptoms) :



Nutrition Intervention (I)
P – Plan

List Nutrition Interventions. Use Nutrition Intervention Terminology sheet. (The intervention(s) must address the problems (diagnoses).


Plan for Monitoring and Evaluation (M E)

List indicators for monitoring and evaluation. Use Nutrition Assessment and Monitoring & Evaluation sheets. (Upon follow-up, the plan for monitoring would indicate if interventions are addressing the problems).


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