| Course | NS310 Nutritional Assessment |
|---|---|
| Unit | Unit 9 |
| Paper type | Assessment case study |
| Length | About 1,180 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | BS in Nutrition Science |
| Updated | October 2026 |
Free sample paper for NS310 Unit 9
A Stable Weight That Hides a Loss: A Unit 9 Assessment Case Study of Muscle and Intake in a Woman With Rheumatoid Arthritis
[Student Name]
Purdue University Global
NS310: Nutritional Assessment
Unit 9 Assessment Case Study
[Instructor Name]
[Date]
The woman, her history, measurements and laboratory values are composite; the cachexia study, malnutrition and sarcopenia consensus reports and ASPEN position paper cited are real.
The Case
D.H. is 61, lives with her husband in Muncie, Indiana, and has had rheumatoid arthritis for 14 years. She takes methotrexate weekly and prednisone 5 mg daily. She was referred by her rheumatologist, who noted that she "looks thinner in the arms and face" although her weight has not changed. She reports fatigue, morning stiffness lasting about two hours and difficulty opening jars and cutting food.
Dietary Evidence
A 24-hour recall using the multiple-pass method recorded about 1,650 kcal and 52 g of protein. Breakfast and lunch were toast with jam and a bowl of cereal, which she can prepare with little use of her hands; dinner, cooked by her husband, was chicken, rice and green beans. She said the day was typical.
At her weight, 52 g of protein is about 0.74 g per kilogram, below the adult Recommended Dietary Allowance of 0.8 g per kilogram. The recall's error runs in a known direction: one day may not be typical, and self-report more often understates than overstates intake. Her own explanation, that she avoids foods that need cutting or opening, is the most useful finding, because it names a cause the clinic can address.
Direction: intake below need, particularly protein. Confidence: moderate.
Anthropometric Evidence
Her weight is 70.2 kg against 70.8 kg a year ago, and at 164 cm her body mass index is 26.1. Waist circumference has risen 4 cm over the year. Mid-upper arm circumference is 27.0 cm and calf circumference, measured seated, is 31.5 cm. Grip strength, the best of three attempts with the right hand on a hand dynamometer, is 14 kg.
These numbers do not agree with one another. Weight and body mass index suggest nothing is wrong. The rising waist suggests fat gain, which prednisone can promote. The arm and calf circumferences are on the small side for her frame, and grip strength is below the 16 kg threshold the European sarcopenia consensus uses to flag low strength in women (Cruz-Jentoft et al., 2019).
Grip strength needs an honest qualification. Her hands are affected by arthritis, so a low reading may reflect joint pain and deformity rather than muscle. The consensus allows a chair-stand test as an alternative measure of strength, and she completed five rises in 17 seconds, which also falls in the slow range.
Direction: muscle lost, fat gained, weight unchanged. Confidence: moderate for muscle loss, given the arthritis.
Biochemical Evidence
Her C-reactive protein is 18 mg/L and her erythrocyte sedimentation rate is raised, showing active inflammation. Albumin is 3.6 g/dL, low in the normal range. Hemoglobin is 11.4 g/dL, mildly low, with a ferritin of 160 ng/mL.
Albumin here reflects inflammation more than nutrition, and should not be used as a marker of protein status (Evans et al., 2021). The mild anemia with normal-to-high ferritin fits the anemia of chronic inflammation rather than iron deficiency, though inflammation raises ferritin and can hide a true iron shortage.
Direction: active inflammation. Confidence: high for inflammation; low for any nutrition conclusion from these values.
Clinical Evidence
On a nutrition-focused physical examination, there is mild hollowing at both temples and visible loss of bulk over the deltoids and the front of the thighs. Her finger joints are swollen and two fingers on the right hand deviate toward the little finger. There is no edema.
Direction: muscle loss at three sites. Confidence: moderate, since the examiner was a student and muscle assessment by eye and touch is subjective.
Synthesis
The streams sort as follows, each with its finding, known error, direction and confidence.
1. Dietary: protein about 0.74 g/kg from one recall; one day, self-reported; below need; moderate.
2. Weight and BMI: stable at 26.1; can hide muscle loss behind fat gain; no change; low as evidence of nutrition status.
3. Muscle measures: small arm and calf, low grip and slow chair stands; arthritis lowers grip; muscle lost; moderate.
4. Biochemical: high CRP and ESR; inflammation is a cause, not a measure of intake; inflammation present; high.
5. Clinical: muscle loss at temples, shoulders and thighs; subjective; muscle lost; moderate.
Four streams point the same way: intake that falls short, active inflammation and muscle that is being lost. Only weight disagrees, and there is a known reason it would.
Rheumatoid arthritis can strip muscle while fat increases, so a woman can lose a meaningful amount of muscle without losing any weight, and in this case the stable scale is the least trustworthy number in the file.
This pattern has a name, rheumatoid cachexia. In a study comparing adults with rheumatoid arthritis with healthy controls matched for weight, body cell mass was 13 percent lower and resting energy expenditure 12 percent higher in the patients, even though their energy and protein intakes were similar to the controls' (Roubenoff et al., 1994). The weights matched; the bodies did not.
Where This Stands Against the Sarcopenia Consensus
The European sarcopenia consensus begins with strength rather than mass: low grip strength or a slow chair-stand test identifies probable sarcopenia, which is confirmed when low muscle quantity or quality is measured (Cruz-Jentoft et al., 2019). D.H. has two independent signs of low strength, one of which, the chair-stand test, does not depend on her hands. That places her in the probable category on the consensus's own terms. Confirmation would need the same body composition measure that GLIM asks for, so a single test would answer both questions. The overlap is useful for the clinic, because it means one referral, not two.
Where This Stands Against GLIM
The Global Leadership Initiative on Malnutrition requires at least one phenotypic criterion, such as weight loss, low body mass index or reduced muscle mass, and at least one etiologic criterion, such as reduced intake or inflammation (Cederholm et al., 2019). D.H. clearly meets an etiologic criterion through inflammation, and probably through reduced intake. Her phenotypic criterion depends on reduced muscle mass, which GLIM asks to be confirmed with a validated measure, such as bioelectrical impedance or imaging, where available. Until that is done, the case study describes her as at high likelihood of malnutrition rather than as diagnosed.
Recommendations for the Referring Clinic
1. Confirm muscle mass with a body composition measure.
2. Refer to an occupational therapist for adapted utensils and jar openers, which address the cause of her low protein intake.
3. Repeat the 24-hour recall on two more nonconsecutive days.
4. Refer to a registered dietitian for an intervention plan, including protein at each meal in forms that need little cutting.
Limits
One recall, one set of measurements and one examination by a student. Grip strength is compromised by her disease. Body composition was not measured directly.
References
Cederholm, T., Jensen, G. L., Correia, M. I. T. D., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., Baptista, G., Barazzoni, R., Blaauw, R., Coats, A. J. S., Crivelli, A. N., Evans, D. C., Gramlich, L., Fuchs-Tarlovsky, V., Keller, H., Llido, L., Malone, A., Mogensen, K. M., Morley, J. E., . . . GLIM Core Leadership Committee, GLIM Working Group. (2019). GLIM criteria for the diagnosis of malnutrition: A consensus report from the global clinical nutrition community. Clinical Nutrition, 38(1), 1-9. https://doi.org/10.1016/j.clnu.2018.08.002
Cruz-Jentoft, A. J., Bahat, G., Bauer, J., Boirie, Y., Bruyère, O., Cederholm, T., Cooper, C., Landi, F., Rolland, Y., Sayer, A. A., Schneider, S. M., Sieber, C. C., Topinkova, E., Vandewoude, M., Visser, M., Zamboni, M., Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), & the Extended Group for EWGSOP2. (2019). Sarcopenia: Revised European consensus on definition and diagnosis. Age and Ageing, 48(1), 16-31. https://doi.org/10.1093/ageing/afy169
Evans, D. C., Corkins, M. R., Malone, A., Miller, S., Mogensen, K. M., Guenter, P., Jensen, G. L., & the ASPEN Malnutrition Committee. (2021). The use of visceral proteins as nutrition markers: An ASPEN position paper. Nutrition in Clinical Practice, 36(1), 22-28. https://doi.org/10.1002/ncp.10588
Roubenoff, R., Roubenoff, R. A., Cannon, J. G., Kehayias, J. J., Zhuang, H., Dawson-Hughes, B., Dinarello, C. A., & Rosenberg, I. H. (1994). Rheumatoid cachexia: Cytokine-driven hypermetabolism accompanying reduced body cell mass in chronic inflammation. Journal of Clinical Investigation, 93(6), 2379-2386. https://doi.org/10.1172/JCI117244
The Purdue Global NS310 Unit 9 instructions
Unit 9 asks students to assess a case using all four types of nutrition assessment evidence and to integrate them into a conclusion. Prompts typically provide a case file with diet, body measurement, laboratory and clinical data. Present each stream separately first, with its own limitations. Give each a direction and a confidence level. Then combine them, looking for agreement and explaining any disagreement. Use current criteria, such as GLIM or a sarcopenia consensus, where they fit. Treat a low albumin as a sign of inflammation unless shown otherwise. Recommend further assessment and referrals within scope. Most case studies run five to six pages. Show any calculations, such as percentage weight change, in full.
How this NS310 Unit 9 example is built
The case opens with the woman's history, medicines and the referring physician's note. The dietary section reports a recall and converts protein to grams per kilogram. Anthropometry shows a stable weight, a rising waist, small arm and calf measures and low grip, with a chair-stand test used because arthritis affects the hands. Biochemical values show inflammation, and albumin is set aside with a source. A physical examination finds muscle loss at the temples, shoulders and thighs. A five-line synthesis rates each stream. The highlighted sentence explains why weight is discounted, and a cachexia study supports it. The case is then placed against the sarcopenia consensus and GLIM, and four recommendations follow.
Reading the NS310 Unit 9 grading rubric
Case studies at this stage are usually graded on how well the student evaluates each stream and how convincingly the streams are integrated. Points go to stating the error in each method as it applies to this person. Explaining a disagreement between streams, rather than ignoring it, is often decisive. Using current diagnostic criteria correctly shows up-to-date knowledge. Recommendations should follow from the gaps in evidence and stay within scope. Accurate calculations, such as protein per kilogram, are checked. Citations and organization are also assessed. Case studies that rely on BMI or albumin alone usually score poorly. Using an alternative strength test when grip is compromised is often credited.
NS310 Unit 9 help: mistakes that cost points
Assessment case studies often present the four streams but never combine them. Another weakness is accepting a stable weight as proof that nutrition is adequate. Some writers use albumin as a protein marker despite clear inflammation. Measurement error is discussed in general terms instead of for this person. Diagnostic criteria are named without checking whether each requirement is met. Recommendations stray into prescribing a diet. Disease effects on measures, such as arthritis on grip, are missed. If the streams in your case seem to disagree, ask whether one has a known reason to mislead. A writer can draft the synthesis around that question. Checking each stream against a disease effect is a quick way to find the one that misleads.
Get an NS310 Unit 9 example written to your instructions
Case files in NS310 Unit 9 vary in age, setting and which streams they include. Forward the case file whole, any required format, and the rubric. Within 24-48 hours the free first custom sample qualifies every stream by its own error, reads all four together into one conclusion and names the referrals that follow from it. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NS310 Unit 9 questions, answered
What if the case leaves out one of the four streams?
Then the case study says so and explains what the missing evidence would have added. Many cases omit laboratory data deliberately. Integration still works with three streams, but confidence in the conclusion should drop, and the example's confidence column shows how that adjustment would be recorded. Inventing values to fill the gap is a serious error.
Where can I find a free NS310 Unit 9 sample paper?
This page has a complete Unit 9 assessment case study of a woman with rheumatoid arthritis whose stable weight hides muscle loss, with all four evidence streams and a synthesis.
What is rheumatoid cachexia?
Loss of muscle and other lean tissue in rheumatoid arthritis, driven by inflammation, often with stable weight because fat increases. One study found body cell mass 13 percent lower than in weight-matched controls.
What are the GLIM criteria for malnutrition?
GLIM requires at least one phenotypic criterion, such as weight loss, low BMI or reduced muscle mass, and at least one etiologic criterion, such as reduced intake or inflammation.
How is grip strength used in nutrition assessment?
As a measure of muscle strength. The European sarcopenia consensus uses below 16 kg for women and 27 kg for men to flag low strength, with a chair-stand test as an alternative.