CASE STUDY - Senior citizen

8/7/2019 CASE STUDY - Senior citizen

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NUTRITIONASSESSMENT

CASE STUDY: SENIOR ADULT

NUTRITION & HUMAN DISEASE

KANCHAN SAAGI

3/4/201

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CASE STUDY(As discussed with Ms. Janelle subjects daughter)

Ms. Heather is a 78 year-old white female widow who lives in an Independent Living (IL) apartment of a

large continuing care retirement community (CCRC). She has support from a daughter and two

daughters-in-law who look in on her regularly. She was diagnosed with chronic atrial fibrillation(couple

of months ago). She visits the CCRC clinic about every three months for regular follow-up, accompaniedby her daughter. Her routine visits were going pretty well until things changed, shortly after her last

visit (3 months ago) her son died and ever since she has been very sad and tearful.

Her daughter presented complaints of mom being fixed on her sons death, noting extreme isolation and

anorexia. There has been weight losssince the last visit (7 lbs in 3 months). In the process, she also

mentioned that over the past 2 years her mother has been more forgetful and less motivated. These

symptoms worsened following the death of her son.

Her eating pattern has been very erratic lately. She was never a big fan of the congregate meals that

were served in the dining room of the CCRC and so the family prepared and delivered it to her but

mostly observed that they were not being eaten.

Grocery shopping together was not much of help as well. But, one thing that they usually noticed was

when she came to their home for a meal or to stay overnight, her appetite was so much better. In

response to thisshe has been invited to live with her daughter, but refuses to leave her own apartment

and is insistent about remaining independent.

Approximately 3 weeks following her visit to the clinic, she was taken to the ER due to a sudden

hypotension attack. In the emergency room she weighed 118 pounds. Her blood pressure supine is

120/76, pulse 86 irregular, which drops to 100/60 and pulse increases to approximately 100 irregular

upon standing. Electrocardiogram: atrial fibrillation approximately 80 to 90. No change from previous

ECG. She was treated with intravenous fluids (500 cc of intravenous (IV) D5 0.5 normal saline) in the

emergency room and feels better after. Her digoxin dose was reduced to 0.125 mg and was discharged

the very same day.

LAB DATA(as provided)

Weight 139 lbs originally

Last visit 118 lbs

Height 55 (165.1cm)

BMI 19.7

BP 130/87 (postural Hypotension 118/72)

Pulse 80 to 90

HEENT edentulous with well-fitting denturesHeart sounds are irregular with a grade Il/VI systolic murmur

Lungs clear

Bowel sounds normal

Extremities w/o edema

Mental status examination revealsshort-term memory loss, poor concentration, and poor insight

Blood urea nitrogen 28; creatinine 0.8; glucose 120; calcium 9.1; serum albumin 3.2; hemoglobin 11.4;

hematocrit 35.1 folate 4.5, TSH 3.2, total T4 6.1.


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MEDICATIONS:Digoxin- 0.25 to 0.125 mg every day

Warfarin 2.5 mg/day

Atenolol - 50 mg/day

Verapamil 30 mg/day

SIDE EFFECTS OF MEDICATIONS:

y Digoxin: loss of appetite, nausea, vomiting, depression & blurred vision.y It also affects the potassium metabolism and may lead to hypokalemiay Warfarin & vitamin K interaction and may interfere with the blood thinning process and

ultimately defeat the purpose of Afib treatment.

y Atenolol B blockers with fluid & electrolyte balancey Verapamil Calcium channel blockerscauses calcium excretion and at the same time can

increase the digoxin levels in the blood as well.

OVERVIEW OF THE CASE ANALYSING HER DISEASE/HEALTH CONDITION & EATING BEHAVIOR

The result of a sudden change in her eating pattern can be attributed to depression but it can also be

emphasized that the drug intake (Digoxin) for the treatment of Afib has been impacting her eating

pattern as a result of itsside effects; loss of appetite and causing her to fixate on her sons death and

make her wallow in depression. All this is cumulatively taking a toll on her eating behavior and in turn on

her health.

I believe it could also be one of the reasons why the Digoxin dosage was reduced over the course. So

keeping all of this in mind, I would basically like to work on a Nutrition prescription that will address

these problems to help improve her intake and regulate her needs that may eventually keep her health

condition (Afib) under control. Not to mention, to discuss ways on how her family can spend more time

with the subject and keep her mind off the loss can do much help as well.

DIET RECALL

Meal Typical diet pattern Current diet pattern

Breakfast Waffles 2 nos/2 toasts & fried

egg/cereal & cold milk 1cup

(2%)/pancakes with maple syrup 2nos

Orange Juice/Coffee

cup oatmeal with skimmed

milk or just 1 toast

Or just 1 cup coffee & crackers

Lunch Sausage 1, olive loaf & coleslaw or

Peanut butter tossed green salad with

Mac & cheese

1 oz. baked chicken with 2 tsp

coleslaw or stuffed whole wheat

bread 1 slice or cup cookedpasta

Tea 1 cup coffee with doughnut/muffin/cherry

pie

Nothing. Very rarely a piece a

fruit

Dinner Spaghetti with spinach sauce/ Ice berg

lettuce dinner roll/cracked wheat or

bulgur cooked

cup herbed soup with1 bread

stick

Post Dinner Ice cream/ pc of pastry Nothing


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REVIEW OF HER DIET

y Typical Diet pattern Presents energy dense food choices, mealsseem to be rich in carbs & fats.Intake of not less than 1800 cals/day is estimated. Food intake is found to exceed the estimated

requirements for her age & corresponding weight.They definitely are not the best of choices to

be included in her days meal pattern and doing so on the long term is more likely to pose health

risks.

y Current diet pattern Food choicesseem to be more or less healthier, but not adequate enoughto meet her nutritional needs. Her food intake seems to be far below her estimated nutritional

requirements which apparently highlight her poor intake (less than 1200 cals/day) and long

term implication ofsuch eating behavior may lead to detrimental health effects.

DIET MODIFICATION:

y Based on finding the root cause of her behavior change affecting her eating pattern: Diseasecondition, medications & psychological condition such as depression & early signs of dementiamanifestations

y Specific modifications;y Well balanced diet to meet her nutritional needs through regular food intake or nutrient

dense food supplements

y Pay attention to include heart healthy food choices (omega fat sources)y Healthy protein rich food sourcesy Avoid caffeinated beveragesy To be aware of Vitamin K rich foods and regulate the intake ofsuch foods with the warfarin

meds

y Keep well hydrated with right amount ofsalt in the diet to maintain Blood pressure.y To have adequate potassium rich foods to make up for the losses due to med interactionsy To initiate intake of a multi vitamin and mineral intake daily in order to improve energy

metabolism and provide adequate amounts of anti-oxidants as well.

Documents

CASE STUDY - Senior citizen