Kendricka Brown

Case Study: Diet for a Patient with Chronic Hunger, Iron Deficiency Anemia, and Lead Poisoning

Jonathan, a two-and-a-half-year-old, lives with his mother and brothers at his grandmother's house in Chicago. His mother, Anita, works at a pharmacy to support the family. Jonathan spends his days at home with his grandmother. While Anita works, his grandmother brings the boys to nearby congregate W.I.C (Women, Infants, and Children Program) site for a hot meal. Jonathan's favorite foods are French fries and strawberry milkshake. He drinks about four glasses (32ozs) of whole milk per day. He also loves grilled cheese sandwiches.

At his W.I.C appointment, the nutritionist asks Anita about Jonathan's food intake and plots his weight and height on growth charts for her to see. She works with Anita on goals for improving Jonathan's nutritional status. The statistics are as follows:

Date of W.I.C Appointment/ Jonathan's Age/ Jonathan's Height/ Jonathan's Weight/ Lab Values: Hemoglobin/ Lab Values: Lead 10.3 10.28/1/05 30 months 35.5 inches 27 lbs 5/2/05 27 months 35 inches 26.5 lbs 2/4/05 24 months 34.5 inches 26 lbs

Based on the information in Jonathan's case study, complete the following tasks:

Step 1: Assessment of nutritional status.

Your first step is to evaluate the anthropometric and biochemical data that is provided in the table above. Do this using the CDC growth grids for infant boys from the day of their birth until they are 36 months old. Plot Jonathan's weight/age, length/age and weight/length in a graph.

What do you notice about Jonathan's rate of growth over the past six months?

•Jonathan’s growth over the past 6 months is falling under the 25% mark which put him at risk for lead poison and anemia.

Step 2: Identify nutritional risk factors.

Nutritional risk factors are any conditions that place a person at risk for malnutrition. The risk may be related to the patient's age, weight, lab values, diet, economics, etc.

List all of Jonathan's nutritional and additional risk factors.

•Jonathan is at risk for iron deficiency because he is not consuming enough iron and eating healthy things. He is also at risk for malnutrition because he is not eating properly and as much as he should. His poor choice of foods puts him at risk as well because he is not consuming the proper nutrients that he needs. Jonathan being a kid he probably plays in dirt and is consuming the lead from the dirt. His family may not be able to afford much food so he doesn’t get to eat all 3 meals.

Indicate which of his nutritional problems are identified in Healthy People 2010: Nutrition and Weight Objectives.

•The nutritional problems that are identified in Health People are iron deficiency, food and nutrient consumption, and food insecurity.

What are the possible nursing interventions directed at Jonathan's nutritional risk factors?

•The nursing interventions that are directed at Jonathan’s nutritional risk factors are referral to a nutritionist or dietician and iron supplementation.

Step 3: Planning and Implementation.

What diet recommendations would you explore with Anita? Is milk a good source of iron? What are the nutritional imbalances that might be associated with the milk intake? Can you make recommendations that would improve his calorie, iron, and zinc intake? How would this affect his lead absorption?

•I would encourage Anita to find healthier things that he likes and cook them. Milk is not a good source of iron instead beans and red meats are. The nutritional imbalances that might be associated with the milk intake is that kids who drink o much milk and not enough food becomes iron deficient because of the lack of iron intake. Ways to improve Jonathan’s calorie, iron, and zinc intake would be to have him eat foods high in iron, more vegetables, and more vitamin c because it helps with the absorption of iron. Also would encourage him to eat more calorie dense food, more protein, and eat more frequently. If he would increase his intake in those areas it would help with his lead absorption because he will have all the proper nutrients and won’t feel the urge to eat the lead.

Would you make any healthcare referrals on his behalf?

•Yes I would make some healthcare referrals on his behalf to a nutritionist.

Step 4: Monitor outcomes.

What outcomes would you like to see?

•The outcomes I would want to see would be that he starts a healthy diet, eating more, increasing his iron intake, and cut backs on all the junk food.

What would be a reasonable time frame to monitor intervention outcomes?

• A three month period will be a reasonable time to monitor his intervention outcomes because that’s how they had started it already so it would be easier to continue it that way and it would be more accurate.