James D

Subject:BiologyPrice:3.87 Bought7

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James D. is referred to your outpatient clinic following a recent admit for complications related to his DM type 2.  James is a 38 YOWM, 5'9" 210# with a L BKA.  He has had multiple admissions to the hospital due to PVD, peripheral neuropathy and dehydration.  His most recent admission was for treatment of a non-healing ankle wound that began as a blister and has progressed into a stage 3-pressure ulcer.  His foot is cyanotic and the admission was for the purpose of debridement.  The physician is quite concerned due to the advanced level of complications in such a young patient.  She has referred the patient to your clinic for aggressive outpatient intervention and education.

 

Lab values:

Albumin:  2.2 mg/dl

Prealbumin 8.9 mg/dl

BUN 52 mg/dl

Creatinine  3.1 mg/dl

Anion gap 12

H/H 10.8/32

Fasting Blood glucose:  210 mg/dl

K+ 4.2 mg/dl

Na +  136

Osmolality 289 mMol/dl

 

24 hour recall:

2 scrambled eggs

3 slices bacon

2 slices toast with butter

2 tsp jelly

8 ounces orange juice

1 cup whole milk

 

Large cheeseburger (McDonald's or Burger King)

Large fries

2-3 pkgs ketchup

apple pie

24 ounce coke

4 slices deep dish pepperoni pizza

3-12 ounce beers

6 oreo cookies

1. Develop a nutritional problem list (2 problems) for this patient in the order of highest to least priority. Be sure to choose nutritional problems not medical problems. Discuss the priority level.  
2. make a calorie count based on the 24 hour recall 
3. make a nutritional assessment on this patient.  This includes anthropometric, dietary and biochemical parameters.  Include estimates of Kcal, protein and fluid needs.  Assess the needs compared to the intakes.  Is his diet adequate? 
4. Determine a plan of care based on your problem list and assessment.  What would be the two most important topics for the patient's nutritional education?  Be Specific in your discussion. HINT: focus on the quality of his diet.