Reference no: EM133689761

Assignment:

Unfolding Case 1

Darius is the first man in his family to reach the age of 60 years without having a stroke or myocardial infarction. He has had hypertension for decades and was recently diagnosed with type 2 diabetes with a hemoglobin Alc of 9.2%. He was immediately prescribed metformin and a basal insulin regimen of 10 units/day and told to lose weight

He is 5 ft 10 in. tall. At the time of diagnosis, he weighed 205 pounds. He wants to lose weight to get off insulin What is his body mass index (BMI)? What risk factors does he have for type 2 diabetes? How much weight should he initially lose?

Is it possible for him to manage his diabetes without insulin?

He has been counseled on basic carbohydrate counting and has a meal pattern that allows him four carbohydrate choices per meal and two for a bedtime snack. His usual dinner is 4 pieces of thick crust cheese and pepperoni pizza and a sugar-free folding soft drink. He was shocked to learn that each piece of pizza counts as 2½ carbohydrate choices. How can Darius continue to enjoy pizza and still adhere to his meal plan?

He developed the flu and was advised to drink plenty of fluids; continue with his four carbohydrates per meal - pattern by using regular ginger ale, fruit juice, and ice cream; and increase his monitoring of blood glucose and ketones. He is reluctant to consume regular ginger ale and ice cream because he knows sugar is bad for him. How do you respond?

He is admitted to the hospital with pneumonia and uncontrolled diabetes. He is ordered a soft diet without any carbohydrate restrictions. He is confused by the lack of restriction and announces he is no longer going to count carbohydrates because it is too confusing and difficult. What strategies are available to help Darius eat a hypocaloric meal plan to promote weight loss and manage diabetes?

Unfolding case 2

Jacob is 49 years old and wants to eat healthier and lose weight. He is 6 ft 1 in. tall, weighs 298 pounds, and does not exercise. His physician advised him to get down 1 250 pounds and told him to follow a 2000-calorie diet. He has prediabetes, hypertension, and hypercholesterolemia. He lives alone and doesn't cook. Instead, he normally eats fast-food meals. He admits to being a heavy beer drinker.

A diet history reveals that his typical first meal of the day is two egg-and-sausage breakfast sandwiches along with coffee, cream, and sugar. Lunch is two peanut butter and jelly sandwiches on white bread with chips and sod. Dinner is a sutmarine

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sandwich, pizza, or tacos. During the evening, he eats chips and salsa while drinking three to four beers. How dices bas asual mtake compare to the ideal diet metrics? What specific suggestions would you make to improve his asual intake?

Is 2000 calories an appropriate weight loss diet for a male? What factors should be considered when deciding whether Jacob should be counseled ' adhere to a DASH diet or a Mediterranean-style eating pattern? Can either pattern be adjusted

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to the appropriate calorie level? Jacob says he prefers a Mediterranean-style eating pattern because it includes wine, which he will drink in place of beer. What does Jacob need to know about alcohol and his CVD risks?

Does he meet the criteria for having MetS? Does his diet contribute to his risk of MetS? What should be Jacob's highest dietary priority? How would you respond when he asks if he can use meal replacements for two meals a day so he doesn't have to think about what to eat?

Unfolding case 3

Sonja is 46 years old, is 6 ft 1 in. tall, and weighs 218 pounds. She has intentionally lost 25 pounds in the last month after donating one of her kidneys. She was extremely moved by the significance of being healthy enough to help a friend through organ donation and recognizes that she must proactively protect her remaining kidney to preserve her own health. She had borderline hypertension before the surgery, is a previous heavy smoker, but has no other medical history. She has adopted a lacto-ovo vegetarian eating pattern and occasionally eats fish

What is her body mass index (BMI? What risk factors for CKD did she have or currently has? What interventions would you suggest to help her maintain kidney health? Is a lacto-ovo eating pattern adequate and appropriate?

A diet history revealed she uses soy protein-based entrees, which she recently realized are high in sodium. Her typical pattern also includes 1 serving of yogurt per day, 1 serving of vegetables, 1 to 2 servings of fruit, and occasionally wholewheat bread. She dislikes milk and gave up sugar-sweetened beverages. She drinks two "large" glasses of wine 3 to 4 days/week and almitted a weakness for white bread and potatoes. When she is stressed, she goes to the vending machine and buys two candy bars and hides them in her clothes so her coworkers won't know she is eating. Does her usual intake qualify as a healthy eating pattern?

What are the positive features of her current pattern? What specific changes can she make in her intake to improve her diet quality? Is her alcohol intake considered moderate? What options would you suggest in place of high-sodium soy entrees?

An increase in her stress level has caused her to give up on her lacto-ovo vegetarian eating pattern. Her blood pressure is increasing, and her weight loss has stalled. To make matters worse, she recently went to an ambulatory care center with excruciating back pain and was diagnosed with kidney stones, which she passed hours after receiving IV fluids. She is worried she will have more kidney stones that may eventually damage her only kidney. What would you tell her about reducing her risk of stone recurrence? What should her nutritional priorities be to maintain kidney health? What other lifestyle interventions would you recommend?

Unfolding case 4

Patrick is 50 years old, is 6 ft tall, and considers himself healthy. His normal adult weight is 258 pounds. He is a "meat-and-potatoes" kind of guy and admits to being sedentary. His beverage of choice is sweetened tea, which he prefers over water. His wife convinced him to have a routine colonoscopy -since it is recommended at age 50 years- which led to a diagnosis of stage 3 colon cancer. He had a partial colectomy and lymph node removal. He is undergoing adjuvant chemotherapy.

He is experiencing anorexia, nausea, vomiting, and mouth sores from chemotherapy and now weighs 236 pounds.

What percentage of his usual weight has he lost? Is that significant? What strategies would you suggest he try to maintain an adequate oral intake?

His weight loss continues and he is having difficulty staying hydrated due to mouth sores and vomiting. Are there additional diet modifications you would recommend that may enable him to consume adequate fluids and calories? Is he a candidate for EN? What are the potential risks and benefits?

He completed the recommended course of chemotherapy and will be closely followed to ensure the treatment was effective. He has high anxiety and fear that the cancer will return and wants to do everything he can to reduce the risk. What would you say to Patrick to help manage his fear? What weight, intake, and exercise goals would you recommend Patrick set?

Reference: Dudek, S. G. (2022). Nutrition essentials for nursing practice (9th ed.).

Wolters Kluwer.