As a nurse in a clinic, you are presented with a 14-year old who weighs 275 pounds and is 5'6" tall. He has gained 60 pounds over the past two years and has begun to withdraw from social activities, and has avoided other students due to bullying from others his age about his weight/appearance. Lately, he has been missing a great deal of school too, particularly on the days he has gym. Jordan's parents are both average in height and weight. Jordan's mother says that he just takes after his grandfather William, who "was a husky man, and died of a sudden heart attack at the age of 44." She says, "We just have fat genes in the family; you cannot do anything about that!" 

He has been told he has "...no willpower, or is weak, and that he needs to change his lifestyle, eat less, and exercise more." Jordan says "I go for a couple days without eating, but then I get so hungry that I could eat the couch!"

Your patient has recently been diagnosed with gallbladder disease and has symptoms that typically occur after eating that include mild pain in the midepigastric region, radiating to the right upper quadrant of the abdomen and right subscapular area of the body.

1. What would you include in your initial assessment data based on the scenario provided?
2. What would you teach Jordan based on the Recommended Daily Allowance from choosemyplate.gov (Links to an external site.)

and the information provided about gallbladder disease?

3. Based on your assessment data and the information from the scenario, what might be two high-priority nursing diagnoses to guide Jordan's plan of care?

 

Answers:

1. What would you include in your initial assessment data based on the scenario provided? 

• The first thing I would do would be confirm the diagnosis with an ultrasound scan. 
• In my initial assessment data, I would like to do nursing assessment and find out his health conditions, including his vital signs, pain level, his daily eating habits, and physical activity.
• I would also like to do thorough assessment to confirm his present diagnosis or any disease associated with his present signs and symptoms. 
• I would also assess his diet and physical activity. 
• I would ask him to keep a diet and exercise journal so that I could assess this more closely on the follow-up visit. 
• Finally, I would like to check his blood glucose and other lab panels to find out his lipids profiles and other disease progression
• Based on the scenario provided, he might be progressing to stroke, hypertension, diabetes, and cholelithiasis, and so on. Symptoms of cholelithiasis typically occur after eating and include mild pain in the mid epigastrium region (Grodner, Escott-Stump, & Dorner, 2016). 

2. What would you teach Jordan based on the Recommended Daily Allowance from choosemyplate.gov (Links to an external site.)

• As a nurse, the first thing I would like to do is to change his daily eating habits. I would help him plan a diet that includes a lot of fibrous foods, like oatmeal and brown rice, and healthy fats, like the kind you get from fish and olives, because they are beneficial to the gallbladder by increasing contraction. I would show them how much calories Jordan needs to consume from proteins, fruits, vegetables, grains, and dairy products as per his health condition, age, gender, height, weight, physical activities, and so on
• I would like to include his family members in the teaching sessions and show them how healthy foods are important to shape individuals health and wellness
• I would teach him not to try to lose weight too quickly because that can exacerbate the issue. 
• I would also encourage him to eat less sugar and refined grains. 
• He needs to be active, so I would teach and recommend him to join after physical exercise program. 
• I would also like to request Jordan to make daily food journal so that I would be easier to make food adjustment in the next visit

3. Based on your assessment data and the information from the scenario, what might be two high-priority nursing diagnoses to guide Jordan's plan of care?

1.The first diagnosis would be: Deficient knowledge related to information misinterpretation as evidenced by the statements:

• "We just have fat genes in the family; you can't do anything about that"
• "I go for a couple days without eating, but then I get so hungry that I could eat the couch"

Plan-of care:

• Both parents and the child do not have enough knowledge about healthy lifestyle behaviors. Jordan and his family need to understand that how obesity and other health issues need to be controlled properly for the severe progression of other diseases.
• Even though he might be risk for family history diseases, but he can control those through proper diet and regular exercises. 

2. Also, Jordan is missing school. He will have anxiety related to separation from friends and school (My second diagnosis). 

Plan-of-care:

• He shouldn't miss school to avoid gym. 
• He needs to have positive behavior so that he can cope with health and school simultaneously. 
• Finally for Jordan, I would recommend to see nutritionists and his primary care provider as often and as needed.

The highest priority would be changing his diet to improve gallbladder function and decrease his chances of developing cholelithiasis. Secondly, I would encourage exercise, which will improve his physical health and also decrease his chances of developing cholelithiasis.

Step-by-step explanation

References:

Grodner, M., Roth, S. L., Walkingshaw, B. C., & Grodner, M. (2012). Nutritional foundations and clinical applications: A nursing approach (6th ed.). St. Louis, MO: Mosby/Elsevier. US National Library of Medicine. (2016, September 28). Gallbladder Diseases: MedlinePlus. Retrieved from https://medlineplus.gov/gallbladderdiseases.html

Grodner, M., Escott-Stump, S., & Dorner, S. (2016). Nutritional foundations and clinical applications: A nursing approach (6th ed.). St. Louis, MO: Elsevier Mosby