Question

Deborah Cranville

Deborah Cranville is a 68-year-old woman who lives with her 65-year-old brother. She has no medical issues other than arthritis. She and her brother are on limited incomes, receiving only their Social Security checks monthly. They cannot afford the upkeep on their vehicle.

            Ms. Cranville’s brother has had a stroke and cannot help with shopping or food preparation. Ms. Cranville has a neighbor who drives her to the store once a week. She buys what she can with her limited income using coupons and buying the weekly specials. She and her brother usually have cold cereal with milk, cranberry juice, and coffee or tea at breakfast. At lunch, they usually have a sandwich or soup with water. Their supper usually includes chicken or pork chops, white bread, mashed potatoes, green beans, and milk. They live in a very small two-bedroom apartment with a small refrigerator and an oven with a cook top.

Critical Thinking Questions

1.      What food supply issues do you notice with Ms. Cranville and her brother?

2.      What key food groups are missing from their routine diet?

3.      What social issues do you recognize?

Dr. Atric

Dr. Gerry Atric asks you to help with a review of a 70-year-old female resident’s medications in his nursing home to determine if drugs may be causing her recent altered mental status and confusion. She normally wheels around the facility in her wheelchair, has a fair appetite, chats with the nursing staff, and participates in most social activities. Other than her recent weight loss, some occasional bouts of diarrhea alternating with constipation, and trouble sleeping, she says that nothing has been out of the ordinary.

After reviewing the patient’s drug regimen, you find that the only new drug she has begun taking is diphenhydramine 50 mg at bedtime as needed for sleep. She has been taking it on a fairly regular basis. Her other drugs (which she has been taking since she was about age 50) include lisinopril 10 mg daily, levothyroxine 75 mcg daily, Prozac 20 mg daily, digoxin 125 mcg daily, aspirin 81 mg daily, fentanyl 50 mcg topically every 72 hours, and Senokot-S twice daily.

Critical Thinking Questions

1.      Can her new medication be contributing to her symptoms? If so, which symptoms?

2.      Although she has been taking most of her medications for about 20 years with good tolerance, why do you still have to consider these medications as potentially contributing to her symptoms? What physiological changes occur with aging that may alter how these medications affect her with time? What physiological change in Ms. Gusi in particular is concerning with regard to her medications?

3.      Which medications should Dr. Gerry Atric be advised to monitor closely to avoid toxicity in Ms. Gusi?

Answer 1

Deborah Cranville

Critical Thinking Questions

1.      What food supply issues do you notice with Ms. Cranville and her brother?

Ms. Cranville and her brother faced the issues of

• Lack of presence of food products within their surroundings to reach easily.
• Buying food products for the whole one week make them unable to maintain the quality of food products.
• Rising of the cost of food products limits their buying.
• They have more chances of food shortages at the end of the week.
• Missing of including variety of food sources in their daily diet.

2.      What key food groups are missing from their routine diet?

They are missing the food group of fruits, legumes, and nuts in their routine diet. These are included as in their daily snacks which have a wide variety of vitamins and minerals.

3.      What social issues do you recognize?

Lack of social support, low-income limits the consuming of more food according to their wish. Agriculture technology doesn't fulfill their food needs. Lack of family support to prepare food for them. Price of food commodities forced them into a nutritionally imbalanced group.