CASE STUDY: DM

I. NUTRITION ASSESSMENT

Introduction

Armando Gutiérrez is a 32-year-old male admitted from the ER to the endocrinology service.

Anthropometric measurements (AD)

 Height (1.1.1), 5’11’’

 Weight (1.1.2), 165 lbs

Biochemical data, medical tests, and procedures (BD)

Chemistry  Triglycerides (mg/dL) , 175 

 Sodium (mEq/L) , 130   HbA1C (%),12.5 
 Carbon dioxide (CO2, mEq/L), 31  C-peptide (ng/mL) ,0.09
 Glucose (mg/dL) ,683   ICA ,+ 
 Phosphate, inorganic (mg/dL),2.1   GADA, +
 Osmolality (mmol/kg/H2O), 306  IAA , +
 Cholesterol (mg/dL), 210

Urinalysis
 pH ,4.9 
 Protein (mg/dL) ,+1
 Glucose (mg/dL), +3 
 Ketones ,+4 
 Prot chk , tr 

Arterial Blood Gases (ABGs)

 pH , 7.31
 HCO3 2 (mEq/L) ,22 

Food-/Nutrition-related history (FH)

 Food intake (1.2.2.5), usual intake for past several months and daily intake of alcohol.
 AM: Toast, jelly, coffee, and scrambled egg
 Lunch: Subway sandwich, chips, diet soda
 Dinner: Usually cooks pasta, rice, vegetables, and some type of meat; eats
out 3–4 times per week at dinner
 Nutrition-related ADLs and IADLs (7.2.1)

Nutrition-focused physical findings (PD)

 Vital Signs:
Temp: 99.6
 Pulse: 100
Resp rate: 24
BP: 78/100
Height: 5'11"
Weight: 165 lbs
 Digestive system (1.1.5), Abdomen: Active bowel sounds
 Nursing Assessment
Abdominal appearance (concave, flat, rounded, obese, distended) ,flat
Palpation of abdomen (soft, rigid, firm, masses, tense) ,tense with guarding

Bowel function (continent, incontinent, flatulence, no stool) ,continent

Bowel sounds (P5present, AB5absent, hypo, hyper)

 RUQ, P
 LUQ ,P
 RLQ ,P
 LLQ P

Stool color, light brown

Stool consistency, soft

Tubes/ostomies, NA

 Genitourinary
Urinary continence, catheter in place
Urine source, clean specimen
Appearance (clear, cloudy, yellow, amber, fluorescent, hematuria, orange, blue, tea), cloudy,
amber
 Integumentary
Skin color, pale
Skin temperature, DI; CLM
Skin turgor (good, fair, poor, TENT5tenting), fair
Skin, intact
Mucous membranes, intact
 Other components of Braden score: special bed, sensory pressure, moisture, activity, friction/shear
(.185no risk, 15–165low risk, 13–145moderate risk, #125high risk), 20

Client history (CH)

 Treatment/therapy (2.2.1), Rx: metformin

 Regular insulin 1 unit/mL NS 40 mEq KCl/liter @ 300 mL/hr. Begin
infusion at 0.1 unit/kg/hr 5 3.7 units/hr and increase to 5 units/hr. Flush new
IV tubing with 50 mL of insulin drip solution prior to connecting to patient
and starting insulin infusion.
  NPO except for ice chips and medications. After 12 hours, clear liquids
when stable. Then, advance to consistent carbohydrate diet order—70–80 g
breakfast and lunch; 85–95 g dinner; 30-gram snack pm and HS.

Personal History (1)

Age: 32 yrs old

Marital status: Divorced

Years education: 16

Language: English/Spanish

Occupation: Computer software engineer

Hours of work: 8–7 M–F, some weekends

Ethnicity: Hispanic

Religious affiliation: Catholic

Tobacco use (CH-1.1.8): Smoker , 1 ppd × 10 years

Patient/ Client/ Family Medical Health History (2)

 Family history:
Father—MI
Mother—ovarian cancer, T2 DM

II. NUTRITION DIAGNOSES

Excessive carbohydrate intake as related to increased alcohol consumption and increased

consumption of carbohydrate-rich foods as evidence by increased blood glucose level , increased
ketone levels and increased HbA1C .

Excessive intake of fat as related to increased high fat consumption as evidenced increased
cholesterol and triglycerides level.

Inadequate fluid intake as related to dry skin and mucous membranes as evidenced by high
osmolality.

Self-monitoring deficit as related to incomplete self-monitoring records such as glucose,

food, fluid intake, weight, physical activity as evidenced by + ICA, GADA, IAA consistent with
type 1 DM vs LADA and overweight.
 III. NUTRITION INTERVENTION

Ideal Goals:

• Healthy diet or specific diabetic diet

• Increased fluid intake

• Engage to physical activities

• Normal general check-up and laboratory test especially the blood glucose level

• Attainment of desirable body weight

• Complete self-monitoring records

Selected intervention: Nutrition Education (E)

 Content (1.2)

*To provide comprehensive education regarding which foods are best for diabetic person that
cannot elevate its blood glucose level.

 Application (2.2)

* Avoiding of foods that can provoke the disease.

Selected intervention: Food and/or Nutrient Delivery (ND)

• Meal and Snacks (1)

ND-1.1 General/healthful diet

ND-1.2 Modify distribution, type, or amount of food and nutrients within meals or
at specified time

ND-1.3 Specific foods/beverages or groups

IV. NUTRITION MONITORING AND EVALUATION

• Food/Nutrition-related history (FH)

Food and nutrition knowledge/skill (4.1.1), to test knowledge and skills weekly

Energy intake (1.1.1), to monitor energy intake weekly

Adherence (5.1.2), to do surprised nutrition visit attendance

Protein intake (1.5.2.1), to monitor CHON intake weekly

Fluid/Beverage intake (1.2.1), to monitor fluid and beverage intake

 Alcohol intake (1.4.1), to disregard alcohol intake

Carbohydrate intake (1.5.3), to monitor carbohydrate intake

 Food and Nutrient Administration (2)

Diet order (2.1.1), to monitor healthy diet

 Behaviour (5)

Self-monitoring at agreed upon rate (FH-5.1.4), to do self-monitoring records on glucose, food

and food intake.

 Biomedical data, medical tests and procedures (BD)

Glucose/endocrine profile (1.5), to monitor glucose level

Lipid profile (1.7), to monitor cholesterol level

Urine profile (1.12), to have a monthly urinalysis laboratory test

 Anthropometric measurements (AD)

*Body weight history (1.1.2), to monitor weight monthly

*Body weight history (1.1.5), to monitor BMI monthly