Subjective data: 89-year-old female patient came in due to lack of appetite as claimed by her
daughter.
Objective data:Patient was a known case of Hypertension and Hypothyroidism and is on
maintenance medications namely Metropolol 12.5 mg per day and Synthroid 075mg per
day.Patient had lost weight of 10lbs for the last 3 months. Patient was not carrdiorespiratoy
distress as vital signs were normal. Patient was noted to have dry oral mucosa, bleeding gums and
poor skin turgor.
In summary,subjective data are data from the patient's point of view or known as symptoms
including feelings, perceptions and concerns while objective data are observable and measurable
signs obtained by the examiner through inspection and physical examination.
1. What two (2) nursing diagnoses can be derived from the problems list?
a. Dehydration
b. Iron Deficiency Anemia
1. What should be included in the plan of care?
a.Urge the patient to drink prescribed amount of fluid.
Oral fluid replacement is indicated for mild fluid deficit and is a cost-effective method for
replacement treatment. Older patients have a decreased sense of thirst and may need ongoing
reminders to drink. Being creative in slecting fluid sources (e.g., flavored gelatin, frozen juice bars,
sports drink) can facilitate fluid replacement. Oral hydrating solutions (e.g., Rehydralyte) can be
considered as needed.
b. Aid the patient if he or she is unable to eat without assistance, and encourage the family or SO
to assist with feedings, as necessary.
Dehydrated patients may be weak and unable to meet prescribed intake independently.
c. If patient can tolerate oral fluids, give what oral fluids patient prefers. Provide fluid and straw at
bedside within easy reach. Provide fresh water and a straw. Most elderly patients may have
reduced sense of thirst and may require continuing reminders to drink.
The nursing interventions for a patient with iron deficiency anemia are:
Administer prescribed medications, as ordered:
·
Administer IM or IV iron when oral iron is poorly absorbed.
·
Perform sensitivity testing of IM iron injection to avoid risk of anaphylaxis.
·
Advise patient to take iron supplements an hour before meals for maximum absorption; if
gastric distress occurs, suggest taking the supplement with meals — resume to between-meals
schedule if symptoms subside.
·
Inform patient that iron salts change stool to dark green or black.
·
Advise patient to take liquid forms of iron via a straw and rinse mouth with water.
Reduce fatigue
·
Stress the importance of frequent rest periods.
·
Monitor hemoglobin, hematocrit, RBC count, and reticulocyte counts.
·
Educate energy-conservation techniques.
·
Encourage patient to continue iron therapy for a total therapy time (6 months to a year), even
when fatigue is no longer present.
Educate the patient and caregivers about iron deficiency anemia:
·
Explain the importance of the diagnostic procedures (such as complete blood count), bone
marrow aspiration and a possible referral to a hematologist.
·
Explain the importance of iron replacement/supplementation.
·
Educate the client and the family regarding foods rich in iron (organ and other meats, leafy
green vegetables, molasses, beans).
1. Calculate the patient's body mass index.
BMI= weight/(height)²
BMI=19.8 Normal
1. How many calories a day does this patient need to maintain her current weight? Explain
your answer.
The patient needs 1200kcal/day to maintain her current weight because she has a sedentary
lifestyle which means only the amount of activity necessary to support independent living.
1. Discuss three (3) laboratory studies that would help determine the patient's nutritional
status. Explain your answer.
a. Electrolytes — especially sodium and potassium — and how well your kidneys are working.
b. Urinalysis. Tests done on your urine can help show whether you're dehydrated and to what
degree.
c. Complete blood count (CBC) is a group of tests that evaluate the cells that circulate in blood,
including red blood cells (RBCs), white blood cells (WBCs), and platelets (PLTs). The CBC can
evaluate your overall health and detect a variety of diseases and conditions, such as infections, and
iron deficiency anemia.
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1. Develop a problems list from the objective and subjective data.
Subjective:
*Poor appetite as claimed by daughter.
Rationale: The patient came to the office with her daughter who presented and expressed a
concern that her mother has not been eating well.
Objective:
* Weight reduction
Rationale: Weight loss was indicated as evidenced by the differential and substantial decrease in
weight of patient from 115 pounds to 105 pounds since the last visit which was three months ago.
-Patient presented with Dehydration
Rationale: Patient have poor skin turgor and dry oral mucus which is an indication of decrease in
body fluid volume, fluid volume deficit or possible dehydration.
-Body Weakness
Rationale: Daughter shops for her mom as she no longer drives. She is eighty nine years old which
raises her risk for decreased muscle strength which may lead to body weakness or ambulation
difficulty.
-Poor Appetite
Rationale: Patient had been taking 0.75 mg of Synthroid every day. This medication is indicated for
Hypothyroidism. One reason for loss of appetite in the elderly could be thyroid issues. In this case,
the patient suffers from Hypothyroidism. Also
-Loneliness or Depression
Rationale: Based on research, the elderly are more prone to social isolation and depression. The
lives alone and she also cooks her meals. This increases risk of her feeling depressed.
2. The following Nursing Diagnoses can be stipulated from this case:
Imbalance Nutrition
Activity Intolerance
Fluid Volume Deficit
3.
*Frequent assessment of patient weight should be done.
Rationale: It will help us to have a baseline for caloric and nutrient requirement needed to be
consumed by the patient, which then will guide us the necessary therapeutic nursing interventions
to be given.
* Assess patient's feelings and perspective of her diet.
Rationale: We can provide nutritional plan for the patient based on her eating perspective. Patient's
may have different perspective toward food type, preparation or handling. Health care personnel
must be knowledgeable of these factors to improve patient's nutritional status.
* Collaborate with a dietitian for complete nutritional assessment and to obtain medical
suggestion or opinions to the nutritional status of the patient.
Rationale: Collaboration with other health care professional is necessary to obtain more medical
knowledge regarding the patient. It also facilitate our goals geared towards achievement of
patient's holistic health status.
* Provide good oral hygiene.
Rationale: Patient already have gum bleeding and dentures loose, thus it is necessary to provide
dental care always. It also help increase appetite and taste on food.
* Patient lacks strength so we can schedule rest periods before meals.
Rationale: Assistance of patient's activities of daily living may be done. Providing rest periods
before meals may help regain patient's strength before the actual meal.
4 The patient’s BMI is 19.8 kg/m2 which is normal.
To compute for body mass index you can use either International System of Units (SI) or the US
customary system (USC).
FORMULA using SI, Metric Unit:
BMI = mass (kg) / height2 (m)
Patient's Data:
Weight: 105 lb
Height: 5 feet, 1 inch
*Convert first weight in pounds (lb) to kilograms (kg) and the height in feet and inch to meters (m)
Weight in kilograms: 47.627kg
Height in meters: 1.549m
*Then proceed with the solution using the given formula:
BMI = mass (kg) / height2 (m)
BMI = 47.627 / 1.549 2
BMI = 47.627 / 2.399401
BMI = 19.8 kg / m2
* Patient's BMI is 19.8 kg/m2 which is normal.
* Here is another method to solve for BMI
FORMULA using USC Units:
BMI = 703 × mass (lbs) / height2 (in)
Patient's Data:
Weight: 105 lb
Height: 5 feet, 1 inch
* Convert first the patient height in feet to inches.
Height in inches: 61 inches
*Then proceed with the solution using the given formula:
BMI = 703 × mass (lbs) / height2 (in)
BMI = 703 × 105 / 61 2
BMI = 703 × 105 / 3721
BMI = 73,815 / 3721
BMI = 19.8 kg / m2
Either of the two can be use as long as you have patient's data such as height and weight. Both
formula will arrive with the same answer.
5. How many calories a day does this patient need to maintain her current weight?
Based on research, active or sedentary women elderly are advised to have 1,600 to 2000 calories
daily, or up to 2,600 if usually active. Patient 24-hour diet reveals approximately 1100-calorie
intake only, which is below the normal calory intake for elderly. Additional 500 calories at least,
should be consumed by the patient to maintain her current weight. Failure to do so may lead to
further weight loss.
6. What laboratory studies would help determine the patient's nutritional status?
* Albumin
* Transferrin
* Prealbumin
* Retinol-binding protein