Question

Case:

MT is a 45-year-old female who lives alone. She has a history of Crohn’s disease that is relatively well controlled. She is currently in the hospital for the treatment of longstanding anemia. Upon assessment, MT reports that her appetite ‘comes and goes’. She states that food has lost its flavor and that she is not interested in eating. When she does it, she reports having mostly snack foods such as chips, crackers, and yogurt. She eats very little fruit and no vegetables. MT is 58kg, 5’ 4” tall and a non-smoker.

During the past 24 hours of hospitalization, MT has eaten a bagel and vanilla yogurt for breakfast with 2 cups of black coffee, crackers and cheese for a snack around 2pm, and 1 bite of pizza for dinner. Before bed, MT did eat a turkey sandwich and a small bag of potato chips. She drinks water periodically during the day.

1.     What is a priority nursing diagnosis for MT related to her nutritional status.

2.     What is 5 interventions for MT based upon the diagnosis chosen.

3.      How will you evaluate the effectiveness of the interventions chosen? What follow-up care does MT need?

4.      If MT’s diet continues to mimic her intake over the past 24 hours what nutritional deficiencies is she potentially at risk for? (Name 3).

Answer 1

Crohn's disease

Crohn's disease is a chronic inflammatory disease that can involve any part of the digestive system from the mouth to the anus. It is also known as regional enteritis.

1. Priority nursing diagnosis

* Imbalanced nutrition : less than body requirements related to inadequate intake of essential nutrients.

/ Altered nutrition, less than body requirements, related to inadequate intake of essential nutrients ( as evidenced by decreased haemoglobin level, anemia)

2. Interventions ( for the above diagnosis)

* Assessment:

- Check the body weight of the patient

- Review laboratory values ( RBC counts and Haemoglobin level)

- Assess physical signs of anemia such as pallor, fatigue, brittle hairs

- Collect the nutritional history of the patient

* Find out healthy body weight for age and height. Obtain the dietician' s help for methods of nutritional support

* Provide good oral hygiene ( as it will promote appetite and taste of food)

*Offer Iron , folic acid and vitamin B12 rich food based on the individual needs ( green leafy vegetables, beans, rice, fish, meat, liver)

* Educate the client regarding iron rich foods such as green leafy vegetables, beans, organ meat and molasses.

* Educate her to avoid caffeinated beverages including cofee ( as it suppress appetite.

3. Evaluation : Evaluation should be on the basis of goal or outcome measurement

Goals/ outcome

* Patient verbalizes the understanding of significance of food that contain essential nutrients ( iron, folic acid and B 12).

* Patient demonstrate changes in the selection of food

* Patient takes adequate amount of food or nutrients

* patient lab reports shows an increase in haemoglobin level.

Follw up

* Instruct the patient to strictly adhere for the follow up visit schedule

* Instruct that she has to contact health care provider if she have any disturbances of Crohn 's disease or in case of any questions

* During follw up assess the 48 hrs nutritional history, monitor body weight, obtain lab values for blood count and Hb.

4. If MT continues the same diet, she might be at risk for nutritional deficiencies such as:

* Iron deficiency ( Iron deficiency is the major cause of anemia)

* Vitamin D deficiency ( MT' s diet is not supplying any vitamin D . Vitamin D is essential for bone and muscles)

* Vitamin A deficiency ( MT's diet is not supplying Vitamin A.; essential for eyes ( vision), skin and mucous membrane .

( She is also prone to Vitamin C as her diet doesn't contain any citrus fruit. She can obtain iodine and Calcium from yoghurt).