NR 228 Week 6 Discussion Question: Case Studies.
Jordan is a 14 year old middle school student, weighing 275 pounds and is 5’6” tall. Over the past
... [Show More] 2 years, he has gained 60 pounds, as he has begun to withdraw from social activities, and avoid other students, due to bullying from others his age about his weight/appearance. Lately, Jordan 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, and 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 can’t do anything about that”!
Answer
He has been told he had “no willpower, or is weak, or that he needed 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” and Jordan says “I go for a couple days without eating, but then I get so hungry that I could eat the couch”!
Jason has recently been diagnosed with gallbladder disease and has symptoms that typically occur after eating that include mild pain in the mid-epigastric region, radiating to the right upper quadrant of the abdomen and right subscapular area of the body. You are the nurse assigned to Jason.
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. 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). Finally, I would like to check his blood glucose and other lab panels to find out his lipids profiles and other disease progression.
As a nurse, the first thing I would like to do is to change his daily eating habits. 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. Secondly, 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. 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.
It seems that both mother and son have deficient knowledge how foods play important role in individuals life. 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” and “I go for a couple days without eating, but then I get so hungry that I could eat the couch”! 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. Also, Jordan is missing school. He will have anxiety related to separation from friends and school. So, 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.
References
Grodner, M., Escott-Stump, S., & Dorner, S. (2016). Nutritional foundations and clinical applications: A nursing approach (6th ed.). St. Louis, MO: Elsevier Mosby.
Response:
If Jordan is not serious about changing his lifestyle modifications, he is at greater risk of progressing to many diseases and illnesses. He is already obese and he has a problem of gallbladder. He has a family history of heart disease, so he is at a greater risk of getting this illness. He and his family need to think and adopt positive lifestyle modifications from their day to day life. Many diseases are cured through proper diet and nutrition (Grodner, Escott-Stump, & Dorner, 2016).He needs proper plan and interventions to eat variety of diets and nutrition with portion control according to myplate.gov. Besides proper diet and nutrition, he needs to do regular physical exercise so that he will remain healthy. He might be getting bullied at the school and that might be the reason he is missing school, or he might be shy to show his body image, so he is withdrawing from his social group. So, it is in the hands of nurse to do thorough assessment and take necessary steps to change his overall health and behaviors by reporting to the school authorities and so on. School is also important because he needs positive behavior to be connected with his peers and other groups. He also needs to visit his doctor regularly to test his lipid profiles and other disease risk factors. The highest priority would be changing his diet to improve gallbladder function and decrease his chances of developing cholelithiasis.
References
Grodner, M., Escott-Stump, S., & Dorner, S. (2016). Nutritional foundations and clinical applications: A nursing approach (6th ed.). St. Louis, MO: Elsevier Mosby.
1. Assess whether nutritional intake provides basic nutrients for optimal health and wellness.
It depends on the diet, but, if one eats varied diet with portion control according to myplate.gov, they should have adequate nutrition. One thing that can be helpful is to make sure that you get a full physical with blood work yearly. They can tell many of your vitamin levels and tell you if you are deficient.
2. Describe nutritional needs for optimal health and wellness throughout the lifespan.
3. Discuss the psychological, sociological, economical, and cultural implications of food on nutritional status.
4. Describe evidence based practice interventions and modifications in nutrition therapy that can positively influence the outcome of disease and illness.
During childhood is a good time for parents to establish good eating habits. Girls during this time need about 1200 to 1800 calories. Boys may need up to 2000 calories to maintain their energy level.
During adolescence, many girls become anemic. Teen-aged girls should increase their iron intake. Children and teenagers can benefit from extra protein so that they have adequate amounts for muscle growth and development. Fatty acids are also important, as is fiber. Teenagers are also experiencing more autonomy. Parents should encourage good choices and discourage empty calories. Girls need about 1400 to 2200 calories during this time and boys need about 1600 to 2600 calories in early adolescence. This increases to 1800 to 2400 for girls and 2000 to 3200 for boys by late adolescence. This is also the time when good exercise habits for life must be developed because active play has usually stopped by this time. Vitamins A, D, K, and B12 are very important during this time, as is calcium so that strong bones are developed early to prevent osteoporosis late in life. Fiber is especially important during adolescence. Teens are also at a high risk for dehydration so adequate fluid intake must be encouraged. During this age, caretakers must monitor for eating disorders. Because of body image issues, eating disorders often develop during this time.
During young adulthood, the body has stopped growing, but it is important to maintain balanced nutrition and activity to prevent conditions like obesity and diabetes, which may be decided by lifestyle. Vitamins C and K are very important along with thiamine, riboflavin and niacin. Women still require additional iron during this time. People should start paying attention to their sodium intake to make sure that it is within healthy limits to prevent hypertension and heart failure later. The choices that a person makes during this time in their life can grossly affect their health later, so good choices are very important.
During middle age, women may experience pregnancy, which comes with special nutritional guidelines. People need to pay attention to their diet to make sure that it is varied and nutritious. This is also especially important because many people experience a natural slow-down in metabolism during this time. The required caloric intake is 1800 to 2200 for women, and 2200 to 3000 for men. This is also a very busy time for both men and women. During this time, people need to learn to schedule health maintenance activities and nutritious meals into their lives to prevent obesity and chronic illness or, between jobs, children, and relationships, it will fall to the wayside.
During later middle age, many people have chronic illnesses that require special diets or maintenance, like diabetes or heart failure. They may be encouraged to eat a DASH diet. Exercise is still important as it can reverse some of the damage caused by disease process and, many times, may eliminate the disease. Important nutrients during this time are folate and vitamin B6 and B12 to prevent homocysteine elevation, which can cause atherosclerosis. Many during this age need to take a daily multivitamin to meet their nutritious needs. Fruits and vegetables, which contain antioxidants and phytochemicals, should be increased during this time to reduce cancer risk. Omega 3 fatty acids are also important for preventing coronary artery disease. Vitamin D and calcium remain important. As women experience menopause, their iron needs decrease.
Beginning in their 50s, hormone production, muscle mass, and strength declines. Kidneys do not function as well, so acid base balance and dehydration are major concerns. Immune function decreases so vaccines are very important. The absorption of vitamins and minerals decreases so it is very important that older adults eat nutrient-dense foods to ensure their nutritional needs are met. Caloric needs during this time range from 1600 to 2800 calories depending on the activity level of the person. Lean protein and healthy fats should be included in the diet. Vitamin D is difficult to get for many older people. They may need supplementation. Vitamin B6 and B12 requirements increase. Many become lactose intolerant during this time. Some also need help with nutrition due to sensory issues, such as dementia, or physical barriers to food preparation, such as Parkinson’s. Also, many people lose friends and life partners during this time. It is especially important to monitor people at this age for depression, which may lead to malnutrition.
References
Zimmerman, M., & Snow, B. (2012). An Introduction to Nutrition. Mountain View, CA: Creative Commons. [Show Less]