Introduction
The human body is sustained by nutritional supplies that are absorbed from the food that is eaten and succesfully digested and ingested. The various forms of nutrients absorbed make energy and create mass for the body as well as protect the body from diseases and harsh environmental conditions. Excessive uptake or lack of these nutritional supplies renders the body weak and vulnerable to diseases. This is more aggravated in cases where the condition endangering a patient’s life is directly linked to nutritional uptake and regulation. An example would be individuals suffering from diabetic conditions. Diabetics have problems which are influenced by the levels of blood sugar as well as indirect factors that influence levels of blood sugar. Therefore, any diabetic should closely monitor their blood sugar levels as well as their sugar intake to achieve an optimal regulation that will not trip the required balance in such a way as to cause immediate or future health related problems. This term paper details an assessment of a diabetic patient. The objective of the paper is to integrate the patient’s details with nursing procedures so as to come up with interventions that can be applied in the effort of imrpoving the patient’s nutritional status.
The patient under assessment is an 82 year old, black African female. She is hospitalized because of fracture on her right hip that requires surgery. She is a sewing machine operator by occupation and has a moderately active, activity level. The patient has a previous history of diabetis and hypertension which could be diabetic related.
The patient’s eating pattern consists of three regularly scheduled meals with intermittent snacks. This perfectly conforms to her eating habits before hospitalization. Daily fluid intake stands at 750 cc/h. Her diet is tailored for a diabetic. She takes no nutritional supplements and has no particular allergies. However, she has a dietary dislike for rice.
Patient’s Medical Profile:
Patient’s Psycho/social information:
The patient is married and lives with her husband. She has three children who live in another city. The black African lady is a quite and serious looking christian. She is well oriented in place, time and location. She however; detests eating at the hospital because she is fond of eating with her husband. As a result, she states that the hospital food does not taste nice. Currently, her medical prescription consists of Senokot, Metformin, Fragmin, Valsartan, Propranolol and Naproxen.
Clinical Findings:
Anthropometric measurements in the clinical findings indicate that the patient was admitted with a weight of 80 pounds which she has neither increased nor decreased. Her height stands at five feet three inches and she has a body mass index (BMI) of 31.2.
Objective Assessment:
| General appearance: Alert, responsive, restless, lethargic. | Responsive |
| Face: skin color, smooth, sunken cheeks, edematous | smooth |
| Lips: smooth, moist
dry, cracked, angular lesions |
dry |
| Tongue: deep pink, moist
red, raw, coated, fissures |
Coated with white spots |
| Teeth: white, condition, multiple carries, absent teeth dentures | Dentures |
| Mucous membranes: deep pink, moist, thin secretions pale, dry, sticky secretions
ulcerations, bleeds easily |
Sticky secretions |
| Skin:color, turgor, rashes, ulcerations, dry, bruising | dry |
| Abdomen: flat, firm protuberant, distended, ascites. | distended |
| Muscles: development, firm, tone
flaccid, atrophy, weak |
weak |
| Eyes: bulging, sunken, dark circles
signs of infection, bright, clear |
clear |
| Vital signs: T 36.5 P 60 R 19 BP 122/56 SaO2 level 99% | |
| Other Observations: | |
Objective/subjective data:
Comments
| Appetite: usual appetite recent changes
recent food intolerances |
Usual appetite |
| Pain: type, location and intensity | Deep pain Right leg 7/10 |
| Nausea: frequency | 0 |
| Vomiting frequency | 0 |
| Diarrhea / Constipation: Frequency
Type of stool |
Constipation post-op |
| Changes in Menstrual patterns: | n/a |
| Frequent infections: | 0 |
| General: weakness decreased activity tolerance mood | Weakness in lower extremities Decreased activity to walk Serious |
| ability to feed self
swallowing / chewing |
Cannot feed herself
Able to Swallow and chew
|
| Other symptoms or complaints: | Her meals are not scheduled as her home eating pattern. |
Biochemical analysis:
| Blood: Hemoglobin
RBC’s Albumin Fasting blood glucose and 2 hour p.c. Total lymphocyte count Cholesterol/Triglycerides/HDL – LDL Urine: BUN, creatinine |
PATIENT’S RESULTS
87L
3.52L N/A N/A 2.20 N/A 7.7H,75 |
NORMAL RANGE
120-160
4.00-5.40
0.80-4.40
2.1-7.5,40-85 |
Nutritional Status assessment form for the patient:
| I have an illness or condition that made me change the kind and/or amount of food I eat. | 2 yes |
| I eat fewer than 2 meals per day | 3 no |
| I eat few fruits or vegetables, or milk products | 2 no |
| I have 3 or more drinks of beer, liquor, or wine almost every day | 2 no |
| I have tooth or mouth problems that make it hard for me to eat. | 2 no |
| I don’t always have enough money to buy the food I need. | 4 no |
| I eat alone most of the time. | 1 no |
| I take 2 or more different prescribed or over-the-counter drugs a day | 1 yes |
| Without wanting to, I have lost or gained 10 pounds in the last 6 months | 2 no |
| I am not always physically able to shop, cook, and/or feed myself. | 2 yes |
| TOTAL | 5 |
| 3-5 | At this score the patient is on a moderate nutritional risk: Therefore;action must be taken to improve her eating habits and lifestyle. It is also recommendable that she should re-check her nutritional score regularly. |
Patient’s Nutritional Assessment and Analysis:
The patient has a normal appetite, however; she experiences constipation. This may be due to polypharmacy effects and /or her elderly age that is characterised with a decreased metabolic rate. The patient has problems with eating alone and she also cannot feed herself, this may eventually reduce her caloric uptake. The patient’s eating is well regulated with no snacks that may cause imbalances in sugar levels. However, her BMI which stands at 31.2 indicates that she is slightly over-weight (Canlas, 2002). This may be due to her moderate levels of activity and may cause her hypertension problems (impaired pulmonary functions).
The patient is at a risk of having further poor digestion and ingestion due to the effect of polypharmacy that may be as a result of the many number of drugs that she is currently using. Coupled with the effect of aging that slows metabolism (due to liver aging and incompetance at old age) the patient’s immune system may get compromised and lead to further post-surgery infections (Zurakowski, 2009 ). Her sedentary life while under hospitalization coupled with weakness that may result from the fact that she does not preffer hospital meals and cannot eat alone, may eventaully; result in impaired pulmonary function. This is because the patient already has a history of hypertension (Canlas, 2002). The lack of family may socially be affecting the patient because she is used to eating with the family and by their assistance. Lack of this company and support may result in her reducing her nutritional intake and this may render her weak and vulnerable.
In order to improve the patient’s nutritional status the family members should be requested to make time to have meals with her. This may make her feel more at home and improve her nutritional uptake because she will get the social company that she desires (Pierce, 2000). Additionally, the patient could be eduacted on the importance of eating a balanced and adequate nutritional meal by emphasizing its importance to her health. The potential negative effect that polypharmacy has on the patient’s digestion can be reduced if her prescription is reviewed to ensure medications prescribed do not adversely affect her digestion and metabolism. Additionally, this can be realized by scheduling eating times in a manner that they do not coincide with the intake of prescriptions (Gnjidic & Hilmer, 2009). The possibility of a low immune system that may render her vulnerable to infections due to poor eating could be reduced by offering her nutritional supplements-vitamin based.
Conclusion
Old age and polypharmacy to a great extent influence the uptake of food and digestion in elderly patients. As a result, the simultaneous use of prescriptions should be closely monitored and adjusted to avoid the negative effect of reducing nutritional uptake. Elderly patients tend to need more social care and attention the lack of which greatly affects their eating habits.
References
Canlas, P. L. (2002).Hypertension: The Silent Killer. Haverford, PA: Infinity publishing.
Gnjidic, D and Hilmer, S. N. (2009). The Effects of Polypharmacy on older adults. The Journal of Clinical Pharmacology and Therapeutics, volume 85, pp 86-88.
Pierce, B. M. (2000). Nutrition Support to Elderly Women: Influence on diet quality. Garland Publishers.
Zurakowski. T. (2009). The Practicalities and Pitfalls of Polypharmacy. The Nurse Practitioner: The American Journal of Primary Health, volume 34, issue number 4, pp 36-41.
