Question

Jasmine is a 65-year-old, non-smoker Hispanic female who is referred by her physician to see you for management of her Type 2 diabetes. She complains of increasing numbness in her feet and occasionally in her fingers, and frequent urination during the day and overnight. She was diagnosed with diabetes type 2 about 10 year ago and has been on metformin drug. However, she was not taking her medicine regularly as she thinks it wasn’t necessary. From interviewing her and reviewing her health record, you learn the following about her:

Education: Low education level (8th standard).

Occupation: Not employed outside the home, babysits infant grandchild on a daily basis

Household Members: Lives with her husband and with one of her four adult children.

Ethnic Background: Latin American, born in Mexico.

Religious Affiliation: Catholic

Language: Native Spanish, speaks English – has difficulty reading English

Patient History: Weighed more than 9 lb at birth.

Family history: Mother had type 2 diabetes

Medical History: Type 2 diabetes, hypertension, hyperlipidemia, hypothyroidism, episodic migraines

Physical exam shows the following:

Weight: 201 lbs.

Height: 5’2” inches,

Temp: 98.6 F

BP: 143/88 mm Hg

Heart rate; 80 bpm

Labs: A1C 9.8%; Total cholesterol 144 mg/dL, LDL 116 mg/dL, HDL 54 mg/dL; Triglycerides (TG) 545 mg/dL.

Recommended lab values

HbA1c

< 7.0%

BP

< 140/90 mmHg

LDL-C

< 100 mg/dL)

TG

< 150 mg/dL

HDL-C

> 40 mg/dL in men

> 50 mg/dL in women

Nutritional history

General: Good appetite, with wide consumption of foods and beverages. She plans and prepares meals for the household.

Performed a 24-hour diet recall.

Breakfast: coffee with milk and sugar (several spoons) + sweet bread 3 to 4 pieces

Lunch: chicken and vegetable soup, home-prepared fruit juice (1-2 x 16ounce glass) + soft drink

Dinner: Largest meal – chicken/beef, rice (2 cups) and beans (1½ - 2 cups), 1 corn tortillas (4-6), home-prepared fruit juice (1-2 x16 ounce glass) + soft drink

Afternoon snack: 1 can “natural” cola 1 3 to 4 sugar-free cookies

Evening snack: Cookies + soft drinks

Food allergies/intolerances/aversions: None

Question 1: Based on above case study, answer the following questions.                                     (Total 9 marks)

            A. Write three Nutrition diagnostic statements (PES) for Jasmine as instructed below:

One PES from intake domain

One PES from medical domain

One PES from behavioral and environmental

            B. Write one Goal for each PES statement, based on signs and symptoms.

Answer 1

Write three Nutrition diagnostic statements (PES) for Jasmine as instructed below:

One PES from intake domain

Imbalanced nutrition more than body requirement related to excessive intake and lack of physical exercise as evidenced by excessive body weight of 201 ibs.

Goal: Patient maintains a well balanced nutrition pattern as per bodys requirement as evidenced by achieving a healthy weight within the normal range.

One PES from medical domain

Ineffective therapeutic regimen management related to knowledge deficit of prescribed regimen as evidenced by verbalization of not taking the medications.

Goal: Patient describes, the understanding of importance of following the medication regimen as evidenced by follow the prescribed medications on time.

One PES from behavioral and environmental

Ineffective health maintenance related to impaired decision making as evidenced by failure to take actions necessary for reducing the associated risks.

Goal: Patient maintains an effective health management regimen by following helathy behaviours to improve health as evidenced by daily practising physical therapy, reducing the excess intake etc.