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Nutritional Assessment of a Medical-Surgical Patient

2807 words (11 pages) Essay in Nutrition

18/05/20 Nutrition Reference this

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Nutritional Assessment on a Medical-Surgical Patient

This paper aims to analyze a typical day’s diet at home of a 61-year female patient admitted at Mountain View Hospital for a back pain radiating to the left leg. This patient underwent a back surgery and developed surgical complications. Furthermore, this paper will compare the patient’s typical diet with the prescribed diet. Analyzing and comparing the client’s diet with the recommended follows and it will end with a plan for diet modifications.

Subject

The subject is a 61-year old Caucasian female. She is married and has two children. She works as a special education teacher at a local high school. She stands 5 feet and 9 inches tall and weighs 109.9 kg. Her BMI is calculated at 35.7.

Typical Day’s Diet

At home, she does not eat breakfast but drinks a glass of Arizona green tea zero calorie.  For lunch, she eats a chicken salad sandwich, three small Mandarin oranges, a glass of Arizona green tea, and a cup of Chobani Coconut Greek Yogurt. For dinner, she eats one cheeseburger with one medium pack of french fries mostly purchased at burger joints like Burger King. She drinks a glass of Arizona green tea afterwards. Finally, after dinner she eats 2 cups of microwaved popcorn and drinks another glass of Arizona green tea. The patient expressed her dislike for drinking water that is why she drinks the green tea all the time.

Nutritional component of diet. Presented in a tabular form hereunder are the typical diet’s nutritional values.

Table 1. Nutritional Component for Diet

Food     Calories Carbohydrate Protein     Fat   Sugar  Dietary  Saturated Sodium Potassium Calcium Iron Vitamin Vitamin

               (Total)      (% kcal)      (%kcal) (%kcal) (g)     Fiber(g)  Fat (g)        (mg)        (mg)         (mg)     (mg)  A(mg)   C (mg)

 

 

 

Arizona

Green Tea  0            0                0                                                              10

 Zeroa (240ml)

 

Chicken sandwich   

2 slices large white

Breada         159         10             14          3                    1.6                         295                      156        2     30

½ cup rotisserie

seasoned chicken

salada         210        1               13          23      6                         2              640                                 <1                   2

Mandarin

Oranges,

Smallb            40         3                  1           0        8           1.4                         1.5       126        28       <1       517      20

Coconut

Greek

Yogurtc        150       40               32          27      12         <1        3.5             50        200       130

Cheese

Burgerb      280        39              21          42       7                        6              560

 

French

Fries,

Mediumb      380        56              5            40                     4                           570

 

Popcorn,

Cooked

2 cupsa         70         34               0           6                                                   110

 

 

 

Data from: a: (Calorie King, 2019); b: (Nutrition Value, 2019); c: (Chobani, 2019)  

Medical diagnosis and prescribed diet

 Patient is diagnosed with gastrointestinal bleed S/P descending colon resection due to bowel injury from a lumbar discectomy related to annular tear of lumbar disc. At the time of patient interaction, she was on her fourteenth post-operative day. She is already on regular diet with no dietary restriction.

Regular diet is designed for the maintenance of ideal nutritional status in those that do not require dietary modifications. This diet minimizes the “risks for chronic diet-related diseases such as cardiovascular diseases and certain cancers (Grodner, Escott-Stump, & Dorner, 2016, p. 264).”

Compare/Contrast

 Table 2 below shows the comparison of the patient’s dietary intake versus the recommended daily allowance for age and gender. It can be inferred that the patient consumed less on most of the recommended total daily allowance. Protein and fat are within the recommended while the patient is trailing behind on her intake of carbohydrates, minerals, and vitamins.   

Table 2. Comparison of patient’s diet with recommended daily allowance

Nutritional component

Patient’s diet

RDA female 51+ (a)

 

 

Calories

1369

1600

Protein, % kcal DV*

15

10-35

Carbohydrate, % kcal DV*

27

45-65

Total fat, % kcal DV*

24

20-35

Sodium, mg

2240

2300

Potassium, mg

Zinc, mg

578

0

4700

8

Iron, mg

<4

8

Calcium, mg

 

Vitamin A, mg

 

Vitamin B6, mg

 

Vitamin B12, mcg

 

Vitamin C, mg

 

Vitamin E, mg

 

Thiamin, mg

 

Riboflavin, mg

 

370

1581

0

0

62

0

0

0

1200

700

1.5

2.4

75

15

1.1

1.1

 

 

Data from (a): 2015-2020 Dietary Guidelines for Americans

* DV: Daily Value

Modification

 Based on the gathered data, her diet falls short from the recommended and considering her surgical complication thus she is at risk for malnutrition. Her prolonged hospital stay coupled with slower progress in recovery could probably due in part to her diminished nutritional state. Therefore, a more in-depth analysis and assessment of her nutrition by a registered dietitian is highly recommended. As recommended by MyPlate, she needs to eat a variety of food from each food groups (Grodner et al., 2016). She especially needs to eat more fruits and vegetables since she is missing a lot of the vitamins and minerals provided by these food groups. Vitamins and minerals are important in wound healing. CDC recommends consumption of 2 to 6.5 cups of fruits and vegetables each day (Grodner et al., 2016). It is also important to encourage the patient to drink water. Diet modification is not easy for anybody. To convince patients to change their diet, nurses must provide appropriate patient education with clear explanations and rationale on why a diet needs to be modified.

Conclusion

The assessment of the nutritional status through analysis of a patient’s typical diet and comparing it with the recommended is an important first step in the identification of those patients at nutritional risk while admitted. Knowing the nutritional risk is an invaluable tool in predicting the outcome and full recovery of a patient. Grodner et al. (2016) noted that “the capacity for recovery from illness or disease depends heavily on nutrition status. (p. 259).”

Grodner et al. (2016) also discussed that hospitalization is stressful enough that it could ruin one’s nutritional status. Undergoing various tests, surgical procedures, taking multiple medications, the frequent interruptions from hospital staff, and the illness itself are stressors that can all result to a decrease in nutritional intake. If the patient’s nutritional status is already compromised to start with, the consequences will be greater. In a study done by Mignini et al. (2018), out of the fifty patients that underwent major surgeries 54% had a compromised nutritional status. These patients with poor nutritional status had poorer stress response after the surgery. The authors suggested that recognizing patients who are potentially at risk of surgical complications through nutritional status assessment is important so that early nutritional interventions could be planned.

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