NUTRITION ASSESSMENTCASE STUDY: SENIOR ADULT

NUTRITION & HUMAN DISEASE

KANCHAN SAAGI3/4/201

1

CASE STUDY (As discussed with Ms. Janelle – subject’s daughter)

Ms. Heather is a 78 year-old white female widow who lives in an Independent Living (IL) apartment of a large continuing care retirement community (CCRC). She has support from a daughter and two daughters-in-law who look in on her regularly. She was diagnosed with chronic atrial fibrillation(couple of months ago). She visits the CCRC clinic about every three months for regular follow-up, accompanied by her daughter. Her routine visits were going pretty well until things changed, shortly after her last visit (3 months ago) – her son died and ever since she has been very sad and tearful.

Her daughter presented complaints of mom being fixed on her son’s death, noting extreme isolation and anorexia. There has been weight loss since the last visit (7 lbs in 3 months). In the process, she also mentioned that over the past 2 years her mother has been more forgetful and less motivated. These symptoms worsened following the death of her son.Her eating pattern has been very erratic lately. She was never a big fan of the congregate meals that were served in the dining room of the CCRC and so the family prepared and delivered it to her but mostly observed that they were not being eaten.

Grocery shopping together was not much of help as well. But, one thing that they usually noticed was when she came to their home for a meal or to stay overnight, her appetite was so much better. In response to this she has been invited to live with her daughter, but refuses to leave her own apartment and is insistent about remaining independent.

Approximately 3 weeks following her visit to the clinic, she was taken to the ER due to a sudden hypotension attack. In the emergency room she weighed 118 pounds. Her blood pressure supine is 120/76, pulse 86 irregular, which drops to 100/60 and pulse increases to approximately 100 irregular upon standing. Electrocardiogram: atrial fibrillation approximately 80 to 90. No change from previous ECG. She was treated with intravenous fluids (500 cc of intravenous (IV) D5 0.5 normal saline) in the emergency room and feels better after. Her digoxin dose was reduced to 0.125 mg and was discharged the very same day.

LAB DATA(as provided)

Weight – 139 lbs originally Last visit – 118 lbsHeight – 5’5” (165.1cm)BMI – 19.7BP – 130/87 (postural Hypotension – 118/72)Pulse 80 to 90HEENT – edentulous with well-fitting denturesHeart sounds are irregular with a grade Il/VI systolic murmurLungs clearBowel sounds – normalExtremities w/o edemaMental status examination reveals short-term memory loss, poor concentration, and poor insightBlood urea nitrogen 28; creatinine 0.8; glucose 120; calcium 9.1; serum albumin 3.2; hemoglobin 11.4; hematocrit 35.1 folate 4.5, TSH 3.2, total T4 6.1.

MEDICATIONS:Digoxin- 0.25 to 0.125 mg every dayWarfarin – 2.5 mg/dayAtenolol - 50 mg/dayVerapamil – 30 mg/day

SIDE EFFECTS OF MEDICATIONS: Digoxin: loss of appetite, nausea, vomiting, depression & blurred vision. It also affects the potassium metabolism and may lead to hypokalemia Warfarin & vitamin K interaction and may interfere with the blood thinning process and

ultimately defeat the purpose of Afib treatment. Atenolol – B blockers with fluid & electrolyte balance Verapamil – Calcium channel blockers…causes calcium excretion and at the same time can

increase the digoxin levels in the blood as well.

OVERVIEW OF THE CASE – ANALYSING HER DISEASE/HEALTH CONDITION & EATING BEHAVIOR

The result of a sudden change in her eating pattern can be attributed to depression but it can also be emphasized that the drug intake (Digoxin) for the treatment of Afib has been impacting her eating pattern as a result of its side effects; loss of appetite and causing her to fixate on her son’s death and make her wallow in depression. All this is cumulatively taking a toll on her eating behavior and in turn on her health.

Meal Typical diet pattern Current diet pattern

Breakfast Waffles – 2 nos/2 toasts & fried egg/cereal & cold milk – 1cup (2%)/pancakes with maple syrup – 2nosOrange Juice/Coffee

½ cup oatmeal with skimmed milk or just 1 toastOr just 1 cup coffee & crackers

Lunch Sausage – 1, olive loaf & coleslaw or Peanut butter tossed green salad with Mac & cheese

1 oz. baked chicken with 2 tsp coleslaw or stuffed whole wheat bread 1 slice or ½ cup cooked pasta

Tea 1 cup coffee with doughnut/muffin/cherry pie

Nothing. Very rarely a piece a fruit

Dinner Spaghetti with spinach sauce/ Ice berg lettuce dinner roll/cracked wheat or bulgur cooked

½ cup herbed soup with1 bread stick

Post Dinner Ice cream/ pc of pastry NothingI believe it could also be one of the reasons why the Digoxin dosage was reduced over the course. So keeping all of this in mind, I would basically like to work on a Nutrition prescription that will address these problems to help improve her intake and regulate her needs that may eventually keep her health condition (Afib) under control. Not to mention, to discuss ways on how her family can spend more time with the subject and keep her mind off the loss can do much help as well.

DIET RECALL

REVIEW OF HER DIET

Typical Diet pattern– Presents energy dense food choices, meals seem to be rich in carbs & fats. Intake of not less than 1800 cals/day is estimated. Food intake is found to exceed the estimated requirements for her age & corresponding weight.They definitely are not the best of choices to be included in her day’s meal pattern and doing so on the long term is more likely to pose health risks.

Current diet pattern– Food choices seem to be more or less healthier, but not adequate enough to meet her nutritional needs. Her food intake seems to be far below her estimated nutritional requirements which apparently highlight her poor intake (less than 1200 cals/day) and long term implication of such eating behavior may lead to detrimental health effects.

DIET MODIFICATION:

Based on finding the root cause of her behavior change affecting her eating pattern: Disease condition, medications & psychological condition such as depression & early signs of dementia manifestations

Specific modifications; Well balanced diet to meet her nutritional needs – through regular food intake or nutrient

dense food supplements Pay attention to include heart healthy food choices (omega fat sources) Healthy protein rich food sources Avoid caffeinated beverages To be aware of Vitamin K rich foods and regulate the intake of such foods with the warfarin

meds Keep well hydrated with right amount of salt in the diet to maintain Blood pressure. To have adequate potassium rich foods to make up for the losses due to med interactions To initiate intake of a multi vitamin and mineral intake daily in order to improve energy

metabolism and provide adequate amounts of anti-oxidants as well.

Research Paper helphttps://www.homeworkping.com/