Question

C.M. is an 89-year-old female who presents with her daughter to the provider’s office. The daughter is concerned because her mother has not been eating well.

Subjective Data

PMH: HTN, Hypothyroid
24-hour diet recall reveals approximately 1,100-calorie intake
Lives alone, daughter nearby
Does not drive
Daughter shops
Patient cooks light meals

Objective Data

Vital signs: T 37 P 72 R 12 BP 104/64
Weight: 105 lb
Weight last visit, 3 months ago: 115 lb
HT: 5 feet, 1 inch
Medications: Metoprolol 12.5 mg per day, Synthroid 0.75 mg per day
Oral mucosa dry, gums bleeding, dentures loose
Poor skin turgor

Questions

1. Develop a problems list. Differentiate from the objective and subjective data.
2. What two (2) nursing diagnoses can be derived from the problems list?
3. What should be included in the plan of care?
4. Calculate the patient’s body mass index.
5. How many calories a day does this patient need to maintain her current weight? Explain your answer.
6. Discuss three (3) laboratory studies that would help determine the patient’s nutritional status. Explain your answer.

Answer 1

Problem list

Subjective data: reduced food intake

Objective data: weight loss

Oral muvosa dry, Skin turgor is reduced ( dehydration)

Loose dentures

Bleeding gums

Diagnosis: Moderate dehydration/Malnutrition/ hypothyroidism/hypertension

Plan of care: hydrate her properly in next 8 hours, either orally or intravenously, encourage her to eat food

BMI= weight in kg/height in meter squared

=47/square of 1.52

=47/2.25

=20.9(approx) ( normal weight)

Her current weight is 47kg(approx)

The calorie required is only 789.6kcal

The calorie required for maintaining her weight 47 kg at the age of 89 is 789.6

As she is sedentary her calorie required is for Basic metabolic rate

-it is calculated as one kcal/hour for every kilogram weight

So it amounts to 1×25×47= 1128kcal

According to FAO after age 40 the requirement decrease by 5percent every decade till 60years and then reduce by 10 percent every decade after 60years

So she is 89 years , it will come to 30 percent

Then we have to reduce 30percent of 1128 kcal

Which is around 338.4 kcal

So she should have 1128- 338.4=789.6kcal/day

lab investigation:

S albumin: the protein available in the body

S. Cholesterol : fasting increased lipid production

S transferrin : the amount of iron predent