Search Assignment Sample For Ireland Students

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This cystic fibrosis case study sample shows one way to structure a clinical reasoning form for a young adult with cystic fibrosis, pancreatic insufficiency and unplanned weight loss, following the Nutrition Care Process. It is based on the University of Limerick clinical nutrition and dietetics case study 2 brief, and it is abridged. For the thinking behind each section, read our guide on how to approach a clinical reasoning form for cystic fibrosis.

Planning table

Question 1: chart review (extract)

Findings are taken from the case chart. Calculations use the charted values: BMI = 54 kg ÷ (1.70 m)² = 18.7 kg/m², and weight loss = (62 − 54) ÷ 62 = 12.9% over 12 months.

Normal sodium, potassium, urea and creatinine suggest hydration and renal function are acceptable now. These values are worth recording so that a change can be spotted later.

Question 2: contributing factors (extract)

Disease and treatment burden. Daily nebulisers, airway clearance and a multi-drug regimen take time and energy, and fatigue after the exacerbation makes meal preparation harder. This is a likely reason for skipped meals (Turck et al., 2016).

Living alone. He lives alone, so no one prompts him to eat or take enzymes. Nearby family support is a strength to build on, for example shared meals on set days.

Knowledge and routine. The recall shows low-fat, low-protein choices. Enzyme use may follow fixed capsule numbers rather than the fat content of the meal; the chart cannot show this, so it needs checking at interview (Cystic Fibrosis Trust, 2016).

Co-morbidity. An HbA1c of 48 mmol/mol raises the possibility of abnormal glucose handling, which would add to catabolism and complicate advice on sugary drinks (Moran et al., 2010).

Inflammation and infection. The raised CRP and neutrophils indicate that increased energy needs and reduced appetite are probably contributing to the loss, alongside malabsorption (Cederholm et al., 2019).

Treatment effects. Modulator therapy has changed the nutritional picture for many adults and can improve weight, but weight loss despite treatment signals that intake and absorption still need attention (Middleton et al., 2019; Wilschanski et al., 2024).

Question 3: outcome measures (extract)

The BMI target follows the adult male goal of about 23 kg/m² in the guidelines (Turck et al., 2016; Wilschanski et al., 2024). Weekly gain rates and the 80% intake threshold are illustrative and should be agreed with the patient and team.

Nutrition Care Process summary (extract)

Assessment (ABCDE)

The headings below follow the Nutrition Care Process and Model (Swan et al., 2017).

Anthropometric: weight 54 kg, BMI 18.7 kg/m², 12.9% loss in 12 months. Using the Global Leadership Initiative on Malnutrition criteria, loss of 10–20% beyond six months and a BMI under 20 kg/m² meet the moderate phenotypic grade, with reduced assimilation and inflammation as aetiological criteria (Cederholm et al., 2019).

Biochemical: CRP and neutrophils raised, albumin low (inflammation), HbA1c 48 mmol/mol.

Clinical: steatorrhoea, bloating, poor appetite, post-exacerbation fatigue.

Dietary: low-fat, low-energy intake with irregular meals. Environmental: lives alone; family nearby.

Nutrition diagnoses (PES statements)

1. Inadequate energy intake related to reduced appetite, skipped meals and increased needs during an exacerbation, as evidenced by a 12.9% weight loss in 12 months and a BMI of 18.7 kg/m².
2. Altered gastrointestinal function related to exocrine pancreatic insufficiency with possible suboptimal enzyme coverage, as evidenced by bulky, pale, oily stools and bloating.
3. Food- and nutrition-related knowledge deficit related to unclear enzyme-to-fat matching and a low-fat convenience diet, as evidenced by the 24-hour recall (to be confirmed at interview).

Intervention

Energy (illustrative). Estimated healthy requirement: Schofield BMR for a man aged 18–29 years is (0.063 × 54) + 2.896 = 6.3 MJ/day. With an activity factor of 1.4 this is about 8.8 MJ/day. Cystic fibrosis needs are given as 110–200% of healthy requirements (Cystic Fibrosis Trust, 2016). A starting target of about 130% gives roughly 11.5 MJ/day (about 2,740 kcal, or 212 kJ/kg), to be adjusted against weight response.

Food first. Three meals and two to three fat-containing snacks, energy-dense and protein-rich, with a fat-containing breakfast and evening snack. Replace the 7UP with a fluid that does not push blood glucose up, pending the glucose test, and raise fluid intake.

Oral nutritional supplements are added if intake stays below the target after one to two weeks, taken with enzymes.

PERT principles. Capsules go with all food and drinks that contain fat, and doses are matched to meal fat content. Guidance suggests about 500–4,000 lipase units per gram of fat and a usual ceiling of 10,000 units/kg/day (Cystic Fibrosis Trust, 2016; Turck et al., 2016). For 54 kg the ceiling is 540,000 units a day. Each Creon 25,000 capsule gives 25,000 units, so three capsules give 75,000 units; for a meal with 30 g fat (illustrative) that is 2,500 units/g. His current maximum on the charted prescription, three capsules at three meals and two with each of three snacks, is 375,000 units a day, or about 6,900 units/kg, so there is room to increase within limits if symptoms persist. Dose changes are agreed with the prescriber, and adherence and timing are checked first. Modulator tablets are taken with fat-containing food.

Vitamins. Review fat-soluble vitamin levels, because Centrum Advance alone is unlikely to be sufficient in pancreatic insufficiency; this is a team decision (Wilschanski et al., 2024).

Monitoring and evaluation

Weight twice weekly as an inpatient, then at every clinic visit; BMI at three to six months in the community (Wilschanski et al., 2024). Review stool pattern, intake against target, oral glucose tolerance test result and vitamin status. If weight does not respond within four to six weeks despite good adherence, escalate to the team to consider enteral nutrition support.

If you want support with a similar form, our case study support and how ordering works pages explain the process. Students in Limerick may also find our Limerick assignment support page useful, and an earlier question on the University of Limerick dietetic assessment and practice brief shows a shorter task of the same type.

References

Cederholm, T., Jensen, G.L., Correia, M.I.T.D., Gonzalez, M.C., Fukushima, R., Higashiguchi, T. et al. (2019) ‘GLIM criteria for the diagnosis of malnutrition – a consensus report from the global clinical nutrition community’, Clinical Nutrition, 38(1), pp. 1–9.

Cystic Fibrosis Trust (2016) Nutritional management of cystic fibrosis. 2nd edn. London: Cystic Fibrosis Trust.

Middleton, P.G., Mall, M.A., Dřevínek, P. et al. (2019) ‘Elexacaftor–tezacaftor–ivacaftor for cystic fibrosis with a single Phe508del allele’, New England Journal of Medicine, 381(19), pp. 1809–1819.

Moran, A., Brunzell, C., Cohen, R.C. et al. (2010) ‘Clinical care guidelines for cystic fibrosis-related diabetes’, Diabetes Care, 33(12), pp. 2697–2708.

Swan, W.I., Vivanti, A., Hakel-Smith, N.A. et al. (2017) ‘Nutrition Care Process and Model update: toward realizing people-centered care and outcomes management’, Journal of the Academy of Nutrition and Dietetics, 117(12), pp. 2003–2014.

Turck, D., Braegger, C.P., Colombo, C. et al. (2016) ‘ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis’, Clinical Nutrition, 35(3), pp. 557–577.

Wilschanski, M., Munck, A., Carrion, E. et al. (2024) ‘ESPEN-ESPGHAN-ECFS guideline on nutrition care for cystic fibrosis’, Clinical Nutrition, 43(2), pp. 413–445.