Case Study #2

Patient:

69 year old male, admitted to NERH 4/13/15, discharged 4/21/15

Admit Weight:

94 kg

Admit Height:

173 cm

Admit BMI:

31.41 (high for age)

IBW:

80.8 kg based on BMI of 27

%IBW:

116%

Diet Order:

initially regular, changed to diabetic 75 g CHO/meal (4/16)

Admitting Dx:

spastic paraparesis, neurogenic bladder, neurogenic bowel, myelopathy,

DM2, venous stasis, transverse myelitis, chronic pain

PMH:

spastic paraparesis 2/2 spinal cord infarct & transverse myelitis, DM2,
chronic back pain, venous stasis, obesity

Nutrition Assessment (initial 4/14): Pt is retired, widowed, and lives at home alone. Per chart
notes pt consumed 100% of dinner last night (4/13). He reports not
following a special diet at home, and states he has a good appetite. He says
he normally eats a lot of frozen foods, such as frozen dinners, frozen
chicken tenders, and jimmy dean breakfast sandwiches. He prefers
microwavable or easy to prepare foods. He states he does not always eat
lunch, and that his weight is stable. He also reports he checks his blood
sugar in the morning, but not always in the evening. Offered DM
education, pt declined at this time, will attempt again at follow up.
Plan: Pt is low nutritional risk with a good appetite and po intake.
Continue to monitor wt trends, labs/meds, and po intake.
Goal: Pt will maintain nutritional status with adequate po intake to best
meet needs.
Diabetic Diet Education: Pt requested education about diabetic diet, he wishes to better control
his blood sugars. Provided him with an explanation and handout
explaining CHO counting, maintaining consistent CHO intake with meals.
Stressed the importance of label reading, as the pt eats frozen foods. Pt
receptive, agreeable, and verbalized understanding. Pt able to verbally
provide accurate teachback.

Long Term Goal: Pt will utilize CHO counting to have better glycemic control.
Labs(4/14):
Hemoglobin (Hgb)
Hematocrit (Hct)
Sodium (Na)
Potassium (K)
Blood Urea Nitrogen (BUN)
Creatinine (Creat)
Calcium (Ca)
Albumin (Alb)
Glucose

11.5 g/dL low

35.0 % low
136
4.0
11 mg/dL
0.74 mg/dL
8.8 mg/dL
3.3 g/dL
158 high

H/H low: noted in physicians progress note (4/14) this is likely anemia of
chronic disease
Glucose high: pt is diabetic, was not on a diabetic diet at the time. POC
blood glucose erratic while pt was on a regular diet, ranging from 75-288.
After diet order changed to diabetic, POC blood glucose better controlled
ranging from 65-139.
Medications:
Amlodipine

Calcium channel

May take w/ food to reduce GI

Aspirin

blocker
NSAID/antithromboti

distress. Avoid natural licorice.

Avoid/limit natural products

which affect coagulation such as

ginger, garlic, gingko, ginseng,
horse chestnut. Avoid alcohol.
May cause nausea/vomiting,

Baclofen

Skeletal muscle

dyspepsia
May cause dry mouth, altered

relaxant

taste, N/V, constipation. Avoid

alcohol. May increase blood

Bisacodyl

Laxative

glucose.
May cause nausea, belching,

abdominal cramps, diarrhea. Do

not take within 1 hour of milk
Citalopram

SSRI

products, Ca or Mg supplement.
Avoid tryptophan supplements,
SJW, alcohol. May cause
increased weight/appetite, dry
mouth, taste changes, N/V,

Divalproex

Anticonvulsant

sodium

diarrhea.
Take w/ meals to decrease GI
irritation. May cause increased
appetite/weight, N/V, dyspepsia,
cramps, diarrhea. Avoid alcohol,

Fentanyl

Narcotic/opioid

increase Ca/vit D intake.

May cause dry mouth, dyspepsia,
N/V, abdominal pain,
constipation, diarrhea. Avoid

Heparin

Anticoagulant

(discontinued
4/20)
Insulin

alcohol.
May cause N/V, abdominal pain,
GI bleeding, constipation.

Antidiabetic/

Balance CHO w/ insulin. May

hypoglycemic

increase weight. Use alcohol w/

caution, may increase

Lisinopril

ACE inhibitor

hypoglycemic effect.
Insure adequate fluid intake.
Decreased Na may be

recommended, avoid salt subs,

caution w/ K supplements. Avoid
natural licorice. May cause
decreased weight, dry mouth,
N/V, constipation, diarrhea.
Limit alcohol. May decrease
Polyethylene

Laxative

glucose in diabetics on insulin.

Not absorbed from GI tract. May

glycol

cause nausea, bloating, cramps,

Pregabalin

flatulence, diarrhea.
Take Mg supplement separately

Analgesic

by 2 hr. May cause increased

appetite/weight, gingivitis, dry
mouth, dyspepsia, N/V, diarrhea,
Simvastatin

Antihyperlipidemic

constipation. Caution w/ alcohol

Decrease fat/cholesterol intake.
Avoid grapefruit, SJW,
substantial alcohol. May cause
nausea, dyspepsia, abdominal

Tamsulosin

BPH Treatment,

pain, constipation, diarrhea.

Take hr after same meal each

Antihypertensive

day. Avoid natural licorice.

Theoretical interaction w/
grapefruit. Avoid alcohol. May
cause dry mouth, dyspepsia,

nausea, abdominal pain,

Terazosin

BPH Treatment,

diarrhea, constipation.
Avoid natural licorice, alcohol.

Antihypertensive

May slightly increase weight.

May cause dry mouth, dyspepsia,
nausea, abdominal pain,
diarrhea, constipation.