Nursing Case Study on Nutrition

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  • 0:03 A Nutrition Case Study
  • 0:45 Assessing Nutritional…
  • 2:31 Nutrition Planning
  • 4:40 Nutrition Plan Implementation
  • 5:37 Evaluating a Plan
  • 6:11 Lesson Summary
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Lesson Transcript
Instructor: Jennifer Reyes

Jennifer has taught Nursing in ADN, BSN, and MSN programs and has a Master's degree in Nursing Education.

This case study will help you, as the student, apply the nursing process to a patient and family who requires nutrition education in order to heal properly from a wound and help reduce health risk factors.

A Nutrition Case Study

Louisa and her daughter Jennifer live in a tiny apartment together. Louisa is a 72-year-old diabetic and has a history of heart disease. Recently, Louisa was loading the dishwasher after dinner one evening when she cut her leg on the corner of the dishwasher. Jennifer helped her clean it and bandage it. After a few days, Louisa was still in a considerable amount of pain and Jennifer noticed her mother's leg was swollen, red, and the wound was weeping. Jennifer decided to take her mother to the hospital, where she was admitted for an infection and started on IV antibiotics. She has been in the hospital for three days now and Karen is her nurse for today. She notices that Louisa does not follow a heart healthy or diabetic friendly diet.

Assessing Nutritional Habits

Karen entered the room this morning and noticed this Ms. Louisa had not touched her breakfast provided by the hospital. Her daughter Jennifer had just arrived and brought Louisa breakfast from her favorite fast food restaurant. Karen also noticed that there were some bags of snack food, such as popcorn, cookies, and chips on the windowsill. Karen assessed Louisa and noted that she had some mild edema in the upper extremities and left lower extremity. The right lower extremity, the leg that had the cut on it, was still pretty swollen, but not as bad as it had been. It was also red and warm. The cut itself was no longer weeping. However, it still appeared open with no scab developed yet. Karen heard mild wheezing in Louisa's lungs and noticed that she got short of breath very easily when getting up to the chair.

After Karen finished her physical assessment, she checked Ms. Louisa's electronic medical record to review the blood work that had been drawn that morning. Louisa had already been weighed that morning by the patient care tech and her BMI had been documented in the record as well. It was 32.4. Karen recognized this as obese. Her albumin level was low, the A1C level was 7.3, glucose was 144, and CBC showed that her hemoglobin and hematocrit were a bit low, so she might be anemic.

Prioritizing a Diagnosis

Based on Karen's assessment, she determined that Louisa was experiencing delayed wound healing due to poor nutritional habits that exacerbated her diabetes and heart disease. Due to Louisa's knowledge deficit, her health and well-being were suffering and at risk. Karen must prioritize her diagnosis and first address the poor wound healing and then educate to reduce the knowledge deficit.

Nutrition Planning

First, to address wound healing. It's important to have an adequate balance of protein in Louisa's diet. Protein is essential to life. It is especially important to promote wound healing. Protein can be found in meats, poultry, seafood, beans, nuts, and seeds. Karen discusses Louisa's hospital diet and discovers that she does not like to eat nuts or seeds, which are often included on her trays. She also talks to Louisa and discovers that Louisa feels the food is too bland and that's why she has her daughter bring in food. Karen reviews the importance of protein. They discuss Jennifer bringing in home cooked meals with more protein, vegetables, and beans in them so that Louisa can get her fill of protein and promote wound healing.

Karen decides to improve Louisa's overall health. She must educate her and her daughter about proper nutrition. In order to develop a proper nutritional plan and utilize the right resources, she decides she must further investigate Louisa and Jennifer's eating habits when at home. She asks basic questions that help her determine Louisa's dietary habits at home, as well as exercise habits. It is quickly determined that Louisa does not exercise, but prefers to read romance novels and watch her television soap operas in the afternoon.

She eats three meals a day that usually consist of rice and meat for dinner and lunch. For breakfast, she enjoys cooking and likes to make pancakes, waffles, biscuits, and eggs. She will also include either bacon or sausage or ham with her breakfast. Louisa will sometimes snack on fruit, such as a banana or orange, but enjoys chips and popcorn. She reports that she does not eat a lot of sweets since she was diagnosed with diabetes. Karen finds out that Louisa cooks three or four nights a week. However, Jennifer will take care of meals on the other nights. These meals are usually store bought prepackaged food or takeout. Karen uses this information to find several pamphlets on diabetes and heart nutrition, since Louisa enjoys reading. She also looks for nutrition-related videos in the hospital's video library.

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