Case Study - Adolescent with Cystic Fibrosis Related Diabetes Mellitus (CFRDM)
Case Overview
Sally Miller is a 16-year-old female being followed in an outpatient CF clinic affiliated with a children’s hospital. On her last three clinic visits, the objective data was as follows:
Date Weight Height Labs
1/07/06 101 lbs 63 1/4 inches
12/10/05 97 lbs 63 inches HgbA1c 7.4, albumin
3.2
Vitamin A 27
Vitamin E WNL
10/13/05 98 lbs 63 inches
Random blood sugar:
129
The RD determined her dietary needs as 2671-3100 kcal and 65-87 g protein (49-57 kcal/kg BW; 1.2-1.6 g/kg). She follows a regular, high calorie, high carbohydrate diet with one Boost Diabetic daily.
Medications include NovoLog:
1 unit: 5g dietary carbohydrates (CHO) at breakfast and lunch
1 unit: 8 g CHO at dinner
20 units NPH BID
Other medications include IV antibiotics, Ultrase MT 20 6/4, vitamins ADEK.
Below is Sally's 24-hour recall:
Food and Quantity
Breakfast
• Toast 2 slices
• Scrambled eggs 2 large eggs
• Orange juice 6 oz
AM Snack
• Banana 1 medium
• Boost Diabetic (240 kcal) 8 oz
Lunch
• Ham and cheese sandwich 2 slices white bread, 2 oz ham, 1 oz American cheese
• Chocolate milk 12 oz
• Apple 1 small(2 inch diameter)
PM Snack
• Cocoa Puffs cereal 3/4 cup
• Whole milk 4 oz
Supper
• Spaghetti 1 cup
• Meat sauce (canned) 1/2 cup
• Tossed green salad 2 cups with 2 tbsp vingarette
• Whole milk 8 oz
• Pound cake 1 slice
H/S Snack
• Homemade high cal protein shake 1 Boost Plus with 1/2 cup ice cream
As Sally’s nursing professional, your role is to understand her nutritional risk factors and reinforce her diet teaching. Please follow the instructions below:
1. Using the ABCDs of nutritional assessment, write a brief nutritional assessment that includes:
a. An analysis of Sally’s anthropometrics. Include % desirable body weight, % weight change, and BMI.
b. Describe the significance of her biochemical data. Are her lab values within normal limits? Do they indicate optimal blood sugar control?
c. Using the exchange lists for meal planning (text, appendix B), estimate Sally’s total caloric intake over the 24-hour period described above. Did she meat her estimated caloric needs on this day?
2. Now that you have analyzed Sally’s objective data, list indicators of potential nutritional problems (nutritional risks). For each nutritional problem, list one intervention that could be tried.
3. Using the exchange lists for meal planning or food labels, estimate the number of grams of total carbohydrates in each of Sally’s meals.
4. Explain to Sally how she can count the total carbohydrates for herself. Be specific: will she need measuring cups, etc? How can she use the exchange lists? How should she read a food label to get grams of carbohydrates?
5. Using her 24-hour recall, explain to her how to determine how much NovoLog to take with her meals.