Question

Mrs. Baxter is an 83-year-old female who has lived with her daughter for the past five years. She has a history of osteoarthritis, hypertension, hyperlipidemia, and occasionally episodes of constipation. She is taking Celebrex for arthritis, Lipitor for hyperlipidemia, Capoten for hypertension, Paxil for depression, a daily multivitamin, and Milk of Magnesia and Dulcolax suppositories as needed for the constipation. Her eyesight is poor, but she is not blind. She ambulates well, but her mental capacity has been deteriorating significantly over the past 6 months and she has difficulty remembering one day from the next. Because of her conditions and the family’s inability to provide adequate attention at home, she was admitted to a long-term care facility one month ago.

Since admission to the long-term care facility, Mrs. Baxter has not been eating well and has lost 8 pounds. She often sleeps through her meals or refuses them, insisting she is not hungry. She has had a difficult transition to the facility, and often cries when her daughter visits, asking to be taken home. Other than her daughter’s occasional visits, she has had no other visitors.

Mrs. Baxter has dentures but refuses to wear them. She states that they have become too loose and will fall out if she tries to eat with them. She doesn’t eat any fruits or vegetables because she finds them hard to chew. She was placed on a soft diet, but stated that she was unable to eat many of the foods.

1.             What is the relationship between nutrition and osteoarthritis?

2.             What other tools might be used to assess Mrs. Baxter’s nutritional status?

3.             What factors may be contributing to her occasional bouts of constipation?

4.             Use the DETERMINE Checklist below to determine the risk of malnutrition in Mrs. Baxter.

•     Disease

•     Eating poorly

•     Tooth loss or oral pain

•     Economic hardship

•     Reduced social contact

•     Multiple medications

•     Involuntary weight loss or gain

•     Needs assistance with self-care

•     Elderly person older than 80 years

Answer 1

1. ANS: Osteoarthritis (OA) is mainly constituted by progressive loss of cartilage tissue, accompanied by a raised thickness of the subchondral plate, osteophytes. Osteoarthritis is linked to precise risk factors or causes including age, joint trauma, injury, or obesity. In this, the synovial fluid decreases, this causes the movement more painful. The relationship between nutrition and osteoarthritis is being overweight. Excess weight affects joints that become stressed and irritated from extra poundage.

Overweight is one of the most important connections between osteoarthritis (OA) and nutrition. Most of the joints affected in osteoarthritis are the weight bearing joints, so weight loss relives the joint pain in overweight patients. The cartilage degradation in OA patients is also associated with the lipid metabolism. Long-chain omega-3 polyunsaturated fatty acids (PUFA) have beneficial effects in OA patients. Increased blood cholesterol levels increase the risk of OA.

2. ANS: Examine what factors are contributing to poor food intake such as food preferences and eating patterns. Look at what nutrients are deficient in her diet and which medications may contribute to malabsorption of vital nutrients. Go over the menu options and food choices available to her at the LTCF, living conditions, economic status, and medical conditions.

3. ANS: Low intake of fiber and inadequate water consumption along with certain medications may be contributing to the occasional bouts of constipation. Also, not getting enough regular exercise may also be a factor

4. ANS: Checklist determines risk of malnutrition in Mrs. Baxter:

•     Disease-possibly Alzheimer’s, hypertension, heart disease, and osteoarthritis

•     Eating poorly-very little or no food at all

•     Tooth loss or oral pain-difficulty with dentures and eating certain foods

•     Economic hardship-lived with daughter for 5 years

•     Reduced social contact-no visitors other than daughter’s occasional visits

•     Multiple medications-Celebrex, Lipitor, Capoten, Paxil, MOM, and Dulcolax

•     Involuntary weight loss or gain-recently lost 8 pounds involuntarily

•     Needs assistance with self-care-needs 24 hour care and supervision

•     Elderly person older than 80 years-83 years old

CONCLUSION: High risk for malnutrition.

Please rate my answer if it is useful to you :) Thank you.