Assessment of the Nutritional State of the Patient - Term Paper Example

Nutrition Term Paper Introduction The primary aim of this paper is to analyze and assess the nutritional state, the potential factors that may put an 84 years old patient named Slavich Giovanni at risk for nutritional problems. In addition, the paper also seeks to determine the possible intervention measures that can be used to improve the health status of the patient. Born in Italy, Slavich Giovanni, who was admitted to the Montreal General Hospital on March 14, 2015, speaks Italian, French and English. The patient’s current primary diagnosis is left hip peri-prosthetic fracture. However, the past medical history reveals that Mr. Slavich Giovanni has cardiac risk factors and is a known diabetes patient suffering from Diabetes Type 2. The patient is currently under the medications including Docusate, Metformin ,Pantoprazole, Quetiapine and Venlafaxine. On the other hand, the past medical history also indicates that the patient has no known medication or food allergies. Mr. Slavich Giovanni’s pre-hospital and hospital eating patterns is consistent with a diabetes diet. He is particularly alert oriented times three at bed rest. However, the patient uses a diaper and has a left hip dressing that requires to be changed as per the protocol as well as an intravenous N/S lock on his right arm. Finally, Slavich Giovanni is also experiencing significant difficulties in transfer of ambulation to his lower extremities, decreased sitting pivot and difficulties in bathing or dressing of the lower extremities due to post surgical restriction. Finally, with regard to the patient’s social history, Mr. Slavich is a widower living at Chartwell Bois- De- Boulogne Retirement Residence, an autonomous private residence apartment. According to patient reports, he keeps in close contact with his son. However, the patient is depressed, suffers from episodes of bipolar disorder, and often gets angry. Nutritional Concerns The primary diagnosis of Mr. Slavich Giovanni’s condition is Diabetes Type 2. Based on the client’s profile including his past medical history, present diagnosis and social history, the three priority nutritional concerns for the patient include: Caloric and nutritional needs Co-existing medical diagnoses Psychosocial issues i. Caloric and Nutritional Needs Mr. Giovanni is an older adult which makes him less active physically. In addition, Giovanni has a left hip peri-prosthetic fracture that reduces mobility. This is particularly critical in determining the patient’s diet and nutritional intake as it means fewer calories will be required. However, despite the low energy requirements of the patient, little amounts of carbohydrates should be provided to the patient sufficient enough to prevent the possibility of hypoglycemia. ii. Co-existing medical diagnoses and Medications The patient is a known diabetic patient currently on medications. For example, the past medical history reveals that Mr. Slavich Giovanni has cardiac risk factors apart from suffering from Diabetes Type 2 and this means the patient may require a special diabetic diet plan that does not aggravate the risk of cardiac problems. In addition, some of the prescriptions may impact on the eating habits of the patient through result in taste changes or digestive complains. iii. Psychosocial issues Based on the presented social history, the client is a widower living alone in a private residence apartment. Despite the reports that he keeps in close contact with his son, the patient suffers from depression, experiences episodes of bipolar disorder, and often gets angry. These conditions may potentially result in anorexia, thereby impacting on his nutritional/ food intake. Analysis The changes in nutritional status among the elderly are attributed to by the physiological changes of aging, current medication, low income, lack of social or emotional support, poor diet, physical disability, and chronic illnesses such as diabetes and cardiovascular diseases. Generally, diabetes type 2 is a chronic condition managed by a combined strategy of diet, medications, exercise, and frequent health monitoring Caloric and Nutritional Needs One of the major nutritional concerns regarding the patient is his nutritional and caloric needs. For example, Due to his advanced age and a left hip peri-prosthetic fracture that reduces mobility, Mr. Slavach is unlikely to engage in much physical activity due his intravenous access and therefore fewer calories will be required in his nutritional intake. Based on his medical history and current diagnosis, the client may be unable to go and shop for healthy foods or even prepare the food due to restricted mobility. The factors mentioned above restrict the physical ability of the patient, and ultimately his caloric and nutritional requirement. According to Sinclair, Dunning and Colagiuri (2013), physical activity helps to reduce the level of plasma glucose by causing its movement to the cells. However, although that Mr. Slavich Giovanni is likely to have low calorie requirement due to his advanced age and diminished physical activity, he may still be at risk of malnutrition as aging patients often suffer from decreased sense of taste and smell as well as a dwindling appetite. Sufficient intake of carbohydrates should be provided to the patient in order to prevent the possibility of hypoglycemia. Lastly, at the age of 84, the patient is also likely to suffer from vitamin and mineral deficiencies that are often associated with old age such as vitamin B1, B12, or C and D deficiencies as well as the deficiency of minerals such as magnesium, zinc, and calcium among others (Kim et al., 2012). Co-existing medical diagnoses and Medications The 84-year old patient is a diabetic patient but has been diagnosed with other medical conditions such as cardiovascular risks. This particularly means the patient may require a special diabetic diet plan that does not aggravate the risk of cardiac problems such as diets with low cholesterol or low saturated-fat diets. Additionally the patient is currently under prescription medication, with many prescriptions including Docusate, Metformin ,Pantoprazole, Quetiapine and Venlafaxine. Generally, some of these prescriptions may result in taste changes and digestive complains, consequently impacting on the eating habits of the patient. Lastly, due to a wound on his left hip, Mr. Slavich Giovanni is likely to require increased protein content in his dietary intake to help in wound healing and prevent infections. Psychosocial Issues Psychosocial issues and situations are a critical concern on the nutrition plan for the diabetes patients. For example, since, Mr. Giovanni is a widower and is living alone in his sun-set years he is likely to suffer from reducing his social support system. Eating is a social event; therefore, social isolation can affect one’s nutritional status considerably. In addition, the patient has depression and bipolar disorder, conditions that could further affect his nutritional intake as depression is often a common cause of anorexia among the elderly. According to many experts, psychosocial issues and problems such as widowhood, retirement and living alone in an assisted living facility often result in significant emotional instability among diabetes patients and may ultimately impact on the quantity of food the patient consume. This may particularly be attributed to the fact that isolation is often associated with poor eating habits and less self-efficacy especially if the victims are elderly persons suffering from a serious chronic disease like diabetes (Kim et al., 2012). Interventions In order to improve the nutritional status of the patient, a number of intervention measures can be implemented to address each of the above three highlighted nutritional concerns. First and foremost to address the first nutritional concern regarding the Caloric and nutritional needs based on his age, medical history and present diagnosis, one of the potential intervention measures would be to patient education where by the patient should be taught on the benefits of having a reduced calorie intake due to their diminished physical activity but at the same time guarantee have sufficient intake of carbohydrates and minerals prevent the possibility of hypoglycemia and other related nutritional issues. In addition, the patient can also be taught on cheaper sources of nutrition dense diets and cost-effective health management monitoring strategies. On the other hand, concerning the issue of co-existing medical diagnoses and medications, the patient may require a special diabetic diet plan that does not aggravate the risk of cardiac problems such as diets with low cholesterol or low saturated-fat diets. In addition, due to a wound on his left hip, Mr. Slavich Giovanni is likely to require increased protein content in his dietary intake to help in wound healing and prevent infections. The client can also be assisted with activities of daily living, medications, feeding, and toileting. Finally, one of the potential intervention measures that can be implemented to address the psychosocial issues as a nutritional concern for the patient is providing emotional support after the loss of his wife and loss of status in the society due to decreasing productivity resulting from aging. For the patient to comply with a long-term therapy plan, psychological health is vital. Mr. Giovanni may also be encouraged to form meaningful social networks where they can share experiences as he lives in a private residential apartment or linked to a psychological support system to assist with the depression (Kim et al., 2012). Conclusion In conclusion, assessing the nutritional state ad needs of elderly diabetes type 2 patients such as Slavich Giovanni is critically important in helping develop various intervention measures that can be used to improve the health status of the patient. For example, knowledge of a patient’s profile including his past medical history, present diagnosis and social history can allow the care givers to develop appropriate measures in order to mitigate some of the potential nutritional risks they may be at risk of suffering from such as due to their advanced age, psychosocial issues, nature of medications as well as co-existing diagnoses. Poor nutritional status could lead to slow wound healing, higher susceptibility to infections, impaired cognitive function, reduced physical activity, and increased mortality rate. References Kim, K.S., Kim, S.K, Sung, K.M, Cho, Y.W, Park, S.W. (2012).. Management of Type 2 Diabetes Mellitus in Older Adults. Diabetes Metab J. 36(5): pp.336-344. Retrieved on April 06, 2015 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486979/ Sinclair, A., Dunning, T., Colagiuri, S. (2013). Managing Older People with Type 2 Diabetes. Retrieved on April 06, 2015 from https://www.idf.org/sites/default/files/IDF-Guideline-for-older-people-T2D.pdf Read More