NUTRITION

ASSESSMEN
T
CASE STUDY: SENIOR ADULT

NUTRITION & HUMAN

DISEASE
KANCHAN SAAGI
3/4/20
11

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, accompanied by 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 loss since 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 this she 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 dentures
Heart sounds are irregular with a grade Il/VI systolic murmur
Lungs clear
Bowel sounds normal

Extremities w/o edema

Mental status examination reveals short-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.

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:
Digoxin: loss of appetite, nausea, vomiting, depression & blurred vision.
It also affects the potassium metabolism and may lead to hypokalemia
Warfarin & vitamin K interaction and may interfere with the blood thinning
process and ultimately defeat the purpose of Afib treatment.
Atenolol B blockers with fluid & electrolyte balance
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 its side 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.
Meal
Typical diet pattern
Current diet pattern
Breakfast

Lunch

Tea

Waffles 2 nos/2 toasts & fried

egg/cereal & cold milk 1cup
(2%)/pancakes with maple syrup
2nos
Orange Juice/Coffee
Sausage 1, olive loaf & coleslaw
or Peanut butter tossed green
salad with Mac & cheese

cup oatmeal with

skimmed milk or just 1
toast
Or just 1 cup coffee &
crackers
1 oz. baked chicken with 2
tsp coleslaw or stuffed
whole wheat bread 1 slice
or cup cooked pasta
Nothing. Very rarely a
piece a fruit
cup herbed soup with1
bread stick

1 cup coffee with

doughnut/muffin/cherry pie
Dinner
Spaghetti with spinach sauce/ Ice
berg lettuce dinner roll/cracked
wheat or bulgur cooked
Post Dinner
Ice cream/ pc of pastry
Nothing
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
REVIEW OF HER DIET

Typical Diet pattern Presents energy dense food choices, meals seem 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.

Current diet pattern Food choices seem to be more or less healthier, but
not adequate enough to 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
of such eating behavior may lead to detrimental health effects.

DIET MODIFICATION:

Based on finding the root cause of her behavior change affecting her eating
pattern: Disease condition, medications & psychological condition such as
depression & early signs of dementia manifestations
Specific modifications;
Well balanced diet to meet her nutritional needs through regular food intake
or nutrient dense food supplements
Pay attention to include heart healthy food choices (omega fat sources)
Healthy protein rich food sources
Avoid caffeinated beverages
To be aware of Vitamin K rich foods and regulate the intake of such foods with
the warfarin meds
Keep well hydrated with right amount of salt in the diet to maintain Blood
pressure.
To have adequate potassium rich foods to make up for the losses due to med
interactions
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.

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