case studies:
1.Mr. DeVita is a 42-year-old male who has been in an accident in which he received severe burns. As a result, he is in severe metabolic stress. Mr. DeVita weighed 186 pounds before the accident. Calculate his protein requirements. Based on the information you have, what are Mr. DeVita's fluid requirements? What are some additional nutritional concerns that you as his nurse, would have with a burn patient? Is nutrition even a real consideration at this point in his care? Why or why not?
2. Katie Burch, a patient with type 1diabetes, reports that she has been experiencing symptoms of hypoglycemia. She wears an insulin pump. However, when she monitors her glucose levels, they are within normal limits. How can you help her understand what could be happening metabolically and physiologically? On further assessment, you find that Katie also has difficulties with dietary compliance. Using your assessment skills, try to identify the obstacles and ways to assist in finding solutions to the problem.
3. Alan is a 58-year-old patient who has the following risk factors for cardiovascular disease: primary hypertension (treated with medication), cigarette smoking, inactive lifestyle, and occasionally eating foods high in sodium. Both of his parents died at young ages due to what Alan calls "heart troubles," and his brother has high cholesterol. As his nurse, you know that risk factors for cardiovascular disease are fixed or modifiable. Give at least two examples of each. What is considered high risk for each variable? For modifiable risk factors, what can be done to reduce risk? How would you counsel Alan?
4. Jordan is a 14 year old middle school student, weighing 275 pounds and is 5'6" tall. Over the past 2 years, he has gained 60 pounds, as he has begun to withdraw from social activities, and avoid other students, due to bullying from others his age about his weight/appearance. Lately, Jordan has been missing a great deal of school too, particularly on the days he has gym. Jordan's parents are both average in height and weight, and Jordan's mother says that he just takes after his grandfather William, who "was a husky man, and died of a sudden heart attack at the age of 44". She says "We just have fat genes in the family; you can't do anything about that"!
He has been told he had "no willpower, or is weak, or that he needed to change his lifestyle, eat less and exercise more." Jordan says "I go for a couple days without eating, but then I get so hungry that I could eat the couch"! You are the school nurse doing height and weight assessments on the middle school group this year. How would you assess and advise Jordan?
5. Michelle, 50 years old, is recovering from breast cancer surgery. She has been experiencing side effects from chemotherapy, particularly nausea and vomiting. Subsequently she has been losing weight, but currently her weight is stable. During the assessment, she mentions that she has been seeing a naturopathic physician to reduce the symptoms related to chemotherapy. Part of this plan includes restricting some fruits and vegetables, fat, and kcal. What, as the patient's nurse, are your concerns regarding these recommendations? What are the dietary requirements that Michelle should have as she undergoes her chemotherapy?