PLEASE CHOOSE ONE CASE AND DESCRIBE YOUR THOUGHTS AND POST YOUR ANSWERS TO THE QUESTIONS along your RESEARCH ARTICLES: Module 1 1. CASE STUDY: MEAL PLANNING
Patient is named Ms. C who is a moderately obese white female, 67 years of age, who has recently been diagnosed with type 2 diabetes. Her doctor has recommended dietary modification and a walking program to manage her diabetes and promote weight loss. No diabetes medications have been prescribed at this time. As the nurse working in her doctor’s office, you are asked to provide Patient C with education on the dietary management of her diabetes. As part of your needs assessment you ask the patient to provide a 24-hour dietary recall. The results and analysis of the dietary content are reported in Table 6.
24-HOUR DIETARY RECALL FOR PATIENT C
Breakfast Black coffee
Mid-Morning 3 oz cheddar cheese 6 wheat crackers 12 oz regular cola Lunch 1/4 lb cheeseburger 1 cup French fries 12 oz regular cola
Afternoon 2 chocolate-covered graham cookies Dinner 3 oz baked chicken breast Small baked potato/2 tsp margarine White
dinner roll/2 tsp margarine 1 cup green beans/2 tsp margarine 8 oz low-fat milk Evening 8 oz low-fat, sugar-sweetened yogurt
1.) After reviewing Patient C’s 24-hour dietary recall, you are able to identify areas where you can most appropriately focus teaching about nutrition, please describe. a. How would you do this?
2.) What areas of concern do you see within the above case and how would you go about addressing them?
3.) Describe a theoretical basis for working with this patient.
4.) List open ended questions you might ask to explore her life situations.
2. Case Study:
Hypoglycemia Patient named Ms. A arrives at her primary care provider’s office for a routine examination. She is a Native American female, 45 years of age, who is 5 feet 4 inches tall and weighs 205 pounds, with a body mass index of 35.3 kg/m2. Her physician is concerned because of her family history of type 2 diabetes, heart disease, and stroke. Ms. A has a past medical history of hypertension and hyperlipidemia. Her blood work reveals an HbA1c of 8.0% (estimated average glucose: 183 mg/dL) and a fasting blood glucose level of 173 mg/dL. A diagnosis of type 2 diabetes is confirmed by further blood work. Ms. A is reluctant to start medications and asks her primary care provider if he knows of any alternative therapies she could utilize instead. After a thorough explanation regarding the benefits of glycemic control in respect to her family and personal past medical history, Ms. A agrees to start taking metformin. She is also referred to an ADA-recognized diabetes self-management education program for information regarding self-blood glucose monitoring, medication management, exercise, blood glucose goals and behavior change, and culturally sensitive meal planning. Ms. A returns in 3 months for a follow-up evaluation of her progress. Her HbA1c remains 8.0% (estimated average glucose: 183 mg/dL), and she states her fasting blood glucose levels are 185–220 mg/dL. She states she has been adherent to her meal plan and has been working outside more often to increase her activity level. She appears frustrated with the lack of improvement. Her primary care provider decides to add a sulfonylurea to the patient’s therapy to increase insulin production. Ms. A is started on glipizide 10 mg twice a day. Additional education is completed regarding the action of glipizide as well as the potential side effects and the importance of eating meals on a consistent schedule to prevent hypoglycemia. The patient and her daughter were both instructed on recognition of signs and symptoms of hypoglycemia and treatment options. Ms. A is able to verbalize all instructions given. One month later, Ms. A’s daughter calls the primary care provider in the mid-morning to report that her mother was working out in the yard and became dizzy, shaky, sweaty, and confused. She is instructed to check Patient A’s blood glucose level and treat for possible hypoglycemia. After the patient’s blood glucose levels are stabilized, the daughter is told to bring the patient to the clinic. The initial blood glucose level is 43 mg/dL. After Ms. A consumes 6 ounces of orange juice, the blood glucose is rechecked in 15 minutes. The result is 87 mg/dL. At the clinic, the certified diabetes educator assesses Ms. A’s medication understanding and adherence. No adverse practices are identified, so further information gathering is completed.
1. From the information gathered so far, it is unclear what Ms. A’s hypoglycemia. Additional areas should be explored?
2. What interventions may be implemented?
Answering all aspects of each case assigned 30
Sharing rationale or references for major points you make in the discussion 40
Identify knowledge gained in researching the case and personal practice implications 15
No attachments to discussion board Paste response 5
Correct spelling, grammar, and APA 6th format 5 Assignment submitted by due date 5 Total 100
Meal Planning Case Study
Nutrition is an important factor of consideration for type 2 diabetes patients who are also obese (Moore et al., 2016). In the case of Patient C, I would focus about educating the patient on the importance of low fat and calorie foods to weight loss and good health. This notion is driven by the fact that C’s diet is majorly composed of high calorie foods which also have high sugar content. This is also the major point of concern evident in the case study. Therefore, focusing on communicating the dangers of foods such as cheese burger and margarine would enlighten the patient on areas where requisite adjustments should be made. I would teach the patient about nutrition by outlining the amount of calories consumed on each type of food and the amount burned after engaging in physical activities. Moreover, I would also stress on the impact of high calorie foods on the patient’s health in general. Having identified that the patient’s food is majorly composed of unhealthy foods as the major point of concern, I would recommend the patient to focus on consuming more fruits and vegetables rather than cheese burgers and fries. Generally, the suggestion requires that the patient replaces all the high calorie foods with low calorie ones. Olsen, Parker and Breiner (2013) indicate that foods that are low in calories facilitate a weight loss process.
The theoretical basis of patient C is founded on the theory of planned behavior. This approach suggests that obese patients can adopt healthy eating habits by regulating their behavior to ensure that they avoid high fat foods (McGaffey et al., 2010). To explore C’s life situations, the following questions will be considered.
- How often do you work out in a week? Please explain your answer.
- Please explain two impacts of unhealthy eating habits to health.
McGaffey, A., Hughes, K., Fidler, S. K., D’Amico, F. J., & Stalter, M. N. (2010). Can Elvis Pretzley and the Fitwits improve knowledge of obesity, nutrition, exercise, and portions in fifth graders? International Journal of Obesity, 34(7), 1134–1142.
Moore, B. F., Clark, M. L., Bachand, A., Reynolds, S. J., Nelson, T. L., & Peel, J. L. (2016). Interactions between Diet and Exposure to Secondhand Smoke on the Prevalence of Childhood Obesity: Results from NHANES, 2007-2010. Environmental Health Perspectives, 124(8), 1316–1322.
Olsen, S., Parker, L., & Breiner, H. (2013). Challenges and Opportunities for Change in Food Marketing to Children and Youth : Workshop Summary. Washington, District of Columbia: National Academies Press.