NUR 208: Nutrition Case Study #3
15 points
Student Name: _________________________________________________
A 35-year-old female is evaluated in the emergency department after experiencing a myocardial infarction in the grocery store. She reports feelings of shortness of breath, chest pain, and pins and needles in her legs for the last few months. She has a history of gastroesophageal reflux disease. She is currently taking antacids, proton pump inhibitors, and statins. She says that she is mostly compliant with these medications, but sometimes she forgets. A 3-diet history is included below. Labs are drawn, and the nurse assessed the client in preparation for needed education and treatment.
Question 1: Highlight the assessment findings that require follow-up by the nurse. (2 points)
Alert, oriented, speech clear and appropriate
Height: 5’6” Weight: 185 lb
Temperature = 99 F (37 C)
Heart Rate = 90 beats/min
Respirations = 25 breaths/min
Blood Pressure = 130/90 mm Hg
Oxygen Saturation = 89% (room air)
Chest pain = mild
Finger stick blood glucose (FSBG) = 140 mg/dL
Total cholesterol = 220 mg/dL
Triglycerides = 140 mg/dL
3 Day Dietary Recall
Day 1
Day 2
Day 3
Breakfast
2 cinnamon rolls with 1 cup coffee
1 c. coffee
1 bagel with 3 tbsp. cream cheese
Lunch
3 c. macaroni and cheese
Cheeseburger with French fries and 16 oz. soda
Sweet and sour chicken with 2 egg rolls
Snack
Chocolate bar
Cherry Strudel
Apple
Dinner
Fried chicken with 1 c. mashed potatoes, 1 biscuit with honey and 8 oz. soda
4 slices of pizza with 8 oz soda
Steak & cheese chimichanga with 1 ice cream sandwich
Question 2: Review the 3-day dietary recall above and analyze the client’s diet history to
determine nutrients that may be missing in the diet. Select all that apply. (2 points)
___ A. Saturated Fat ___ D. Sodium ___ G. Fiber
___ B. Vitamins ___ E. Minerals ___ H. Protein
___ C. Sugar ___ F. Cholesterol
Question 3: Choose the most likely options for the information missing from the statement below by selecting from the lists of options provided. (1.5 points)
The client most likely has Type 2 Diabetes Mellitus due to increased ______ ______ based on her weight, age, and ______.
Option 1
Option 2
Option 3
insulin
resistance
fasting plasma blood glucose levels
glucagon
secretion
gastroesophageal reflux disease
cholecystokinin
sensitivity
dyspnea
Question 4: Use an X to indicate whether the nursing educations listed below are Indicated
(appropriate or necessary), Contraindicated (could be harmful), or Non-Essential
(make no difference or are not necessary) for the client’s care at this time. (3 points)
Nursing Education
Indicative
Contraindicated
Unrelated
Aim for <2,300 mg to lower blood pressure.
Consume 50 g/day of fiber to lower cholesterol.
Aim for 2-3 daily servings of fruits and vegetables.
Consume red meat frequently.
Aim for 150 minutes of moderate physical activity every other week.
Understand differences between long acting and rapid acting insulin.
Question 5: Use an X to indicate whether the nursing action listed below are Indicated
(appropriate or necessary), Contraindicated (could be harmful), or Non-Essential
(make no difference or are not necessary) for the client’s care at this time. (3 points)
Nursing Action
Indicated
Contraindicated
Non-Essential
Request low fiber lunch tray from dietary services.
Provide client with cardiac diet menu for meals.
Administer 500 mg of Metformin orally.
Insert urinary catheter.
Prepare for nasogastric tube placement for bowel rest.
Monitor carbohydrate intake at meals and aim for consistent grams of carbs at each meal.
Question 6: For each client response, use an X to indicate whether the nurse’s teaching was
Effective (helped the client understand the procedure), Ineffective (did not help the client understand the procedure), or Unrelated (not related to the health teaching about the procedure). (3.5 points)
Client Response
Effective
Ineffective
Unrelated
“I need to reduce my intake of processed foods such as chips and meats.”
“Fluids such as water and milk provide more nutrients compared to soda.”
“Whole grains, fruits, and vegetables provide fiber that will help reduce my blood pressure and cholesterol levels.”
“I should reduce my calorie intake by skipping meals.”
“Metformin is a medication that will help control my blood sugars.”
“Instead of exercising, I should get weight loss surgery instead.”
“A unit of insulin covers about 15 grams of carbohydrate.”