Clinical Nutrition and Dietetics Case Study 2: Clinical Reasoning Form for a Young Adult with Cystic Fibrosis and Weight Loss | University of Limerick

This dietetics case study moves from the patient’s chart to clinical reasoning. Using a case of a young man with cystic fibrosis who has lost weight, students must set out the nutrition-related signs and their likely causes, the factors driving his referral to dietetics, and the outcome measures that will show whether the nutrition plan is working.

Clinical Reasoning Form Questions

Answer the Clinical Reasoning Form questions using the case study and the completed NCPM. All responses must be supported by high-quality evidence, including peer-reviewed research published within the last 10 years, systematic reviews, randomised controlled trials and current evidence-based clinical guidelines where available. Word count: 1,050 words.

Question 1 (about 500 words)

After reviewing the patient’s chart (medical, nursing, observations, medication record, blood results etc.), complete the table to describe the nutrition-related concerns, with these columns:

• Sign(s): objective
• Symptom(s) as reported in the patient’s chart
• Possible causes (aetiology)
• How this can be confirmed during the dietitian-patient interview or anthropometric examination: what you must, should and could find out or do

Question 2 (about 300 words)

What are the factors (e.g. psychosocial, cognitive, co-morbidities) that may have been contributing to the patient’s medical condition and/or reason for referral to dietetics, as reported in the patient’s chart? Present each contributing factor with the reason for your answer.

Question 3 (about 250 words)

What outcome measures will you choose to assess the effectiveness of your treatment, having assessed the patient/client?

Case Study 2

John is a 22-year-old male with a diagnosis of cystic fibrosis complicated by pancreatic insufficiency and recurrent respiratory infections. He was admitted to hospital on 8 September 2026 following a pulmonary exacerbation (worsening of lung or respiratory symptoms) characterised by increased cough, sputum production, fatigue and reduced exercise tolerance. He lives alone but has good family support nearby.

Over the past 12 months, John has experienced unintentional weight loss, with his weight decreasing from 62 kg to his current weight of 54 kg. His height is 1.70 m. He reports a reduced appetite, often skipping meals when busy or feeling fatigued. He reports frequent bulky, pale, oily stools and occasional abdominal bloating.

Biochemical profile

• CRP: 42 mg/L (high)
• Neutrophils: 9.5 ×10⁹/L (high)
• Albumin: 31 g/L (low)
• HbA1c: 48 mmol/mol (high)
• Sodium: 136 mmol/L (normal)
• Potassium: 4.3 mmol/L (normal)
• Urea: 4.8 mmol/L (normal)
• Creatinine: 68 μmol/L (normal)

Current medications

• Creon 25,000: 3 capsules with main meals and 1–2 capsules with snacks
• Centrum Advance: once daily
• Nebusal 7% hypertonic saline: 4 mL nebulised twice daily (helps clear thick mucus from the lungs)
• Pulmozyme 2.5 mg: nebulised once daily (thins thick mucus in the lungs)
• Trikafta: two tablets each morning (elexacaftor 100 mg/tezacaftor 50 mg/ivacaftor 75 mg per tablet) and one ivacaftor 150 mg tablet each evening (CFTR modulator)
• Azithromycin 500 mg: three times weekly (Monday, Wednesday, Friday)
• Salbutamol inhaler 100 micrograms: 2 puffs as required before nebulised therapies

24-hour recall

• Breakfast: toast ×2 with butter and jam; cup of tea
• Lunch: packet of crisps; chocolate bar; 330 ml can of 7up
• Dinner: small portion of chicken and potatoes
• Snacks: occasional biscuit or fruit
• Fluids: approximately 1 litre/day

Note: weight loss of more than 5% of usual body weight over 6–12 months is considered significant (>5% in 1 month, >7.5% in 3 months, >10% in 6 months).