Reconsiderations B
1- Dysphagia is difficulty swallowing and dysphasia is a lack of coordination of speech.  
It will probably not go away and it is generally progressive in severity.  
3- What we meant by the nitrogen to creatinine ratio was the somatic protein pool is 
directly proportional to how much creatinine is excreted.  In a marasmic patient there 
is measurable somatic protein wasting.  In our patient we want to reverse this so 
through feeding the ratio is maintained.
4- The name of the equation that is used to calculate IBW is Honway (unsure of 
spelling)

SOAP Note
A:  This pt. Is marasmic due to certain factors that are all symptomatic to this condition:
TSF = TSF measures body fat and this pt. Was in the 5th percentile.  This shows a 
significant decrease in body fat stores.
UAMA= This pt. Is between the 5th and 10th percentile.  She is demonstrating muscle 
wasting.  In a marasmic patient there is a decrease in UAMA as well as somatic protein.
Her wt. On admission was 112 lbs. And her usual wt. Was 135 lbs.  Such a large decline 
in body weight is indicitive of malnutrition leading to marasmus.

On admission pts. Albumin level was normal showing that her somatic protein  was not 
affected do to her adaptive response.  The other biochemical data we used earlier in our 
objective data was all due to hydration status (ex, BUN, Hematocrit, and Na).  We 
decided to omit the dehydration from her assessment therefore we are not discussing 
these values here.  

Our goals for this patient are to sufficiently rehydrate the patient and decrease risk of 
future dehydration after discharge.  Increase her P.O. intake.  Maintain nutritional status 
to avoid exacerbating AlzheimerÕs complications.  Maintain her PRO status while 
repleting overall energy.

Kcal needs were 1181, protein needs were 52 g, fluid needs were 1300 ml.  These values 
were calculated so that the pt. Is maintaining her biochemical data.
Her mode of nutrition is enteral with the use of osmolite formula.  Pt. Will be receiving 
feedings six times per day.  Her longterm is 185 ml every 3hrs. To avoid complications 
her first two feedings will be 120 ml. And feedings 3,4,5 will be 180 ml, and feeding 6 
will be 185 ml, which is our goal.  Pt. Needs 375 ml of additional water to be given 
through amounts of 30 ml before and after every feeding.  She also needs an additional 
10 g of PRO through two scoops of promod.

P:  To initiate the TF we are going to give 120 ml Q two H for two sessions.  180 ml for 
three sessions and 185 ml for each session thereafter.  The things we will be monitoring 
will be electrolytes, BUN, Ca, Mg, P, Glucose, and also monitor body wt. , fluid IO and 
bowel function daily.