Obert G.

Noble
BSN – 4 NB

Case Study 1:

Nutrition-Physical Activity James has been gaining weight over the last five years in his
group home and his doctor has said that he needs to exercise more or he will become
obese. James is 62, a large man weighing around 200 pounds, who really doesn't want to
be told that he needs to exercise for his health. When James first came to the group home
he was much more active than currently. He would go for walks in Sunrise Park by himself
when the weather was good and he seemed to enjoy that. He also bowled every week with
the other men in the group home and was very good at it. A year later James climbed Mt.
Clemons with one of the staff. Unfortunately, the staff person left his job at the group home
about three months later and no one else was interested in taking him hiking. He worked
out at the YMCA for a period of time but he didn't find other people to workout with him and
he quit. We think that James started eating more food within the next year as he started to
gain weight.

Management:

Setting a goal for weight loss is the first step in planning a weight loss program. The
patient needs to accept that the goal is reasonable, realistic, and attainable. An initial
weight loss of 5–7% of bodyweight within 6 months is achievable. Dietary intervention is
the cornerstone of weight loss therapy. Most of the dietary regimens proposed for weight
loss focus on energy content and macronutrient composition. It is the energy content that
determines the efficiency of the dietary regimens. Obesity treatment guidelines issued by
the NIH recommend that persons who are overweight or who have class I obesity and who
have two or more risk factors should reduce their energy intake by 500 kcal/day.9 Persons
with class II and class III obesity should strive for 500–1000 kcal/day reduction. With a
reduction of 500 kcal/day energy intake, a weight reduction of 0.5 kg/week can be
achieved. As in this case, someone just needs to workout with James to have motivation
and to socialize with other people. The best suggestion to give to James is to socialize
more and meet new people who are interested in what he wants to do. Physical activity
alone is not an effective method for achieving initial weight loss, although most overweight
Obert G. Noble
BSN – 4 NB

or obese people tend to choose exercise as the first interventional option. Without calorie
restriction, weight loss through exercise alone is quite small, about 0.1 kg/week

Questions

1.) You are taking care of a patient with severe COPD. What type of diet would best suit this
patient's needs?

 Cut apples, fresh broccoli, and grilled chicken

 Pureed sweet potatoes, ground turkey & gravy with mash potatoes
 Green beans, boiled carrots, and steamed fish
 Fried chicken, French fries, and pudding

A patient who has COPD will have difficulty breathing and the slightest activities can cause shortness
of breath. Therefore, the patient would need something that is very easy to eat and requires minimal
chewing. The best option here is pureed sweet potatoes, ground turkey & gravy with mash potatoes.

2.) A patient who has a colostomy is complaining about having excess gas. You ask the
patient to tell you what he has ate in the past 48 hours. Which food would you suspect is
causing the patient excessive gas?

 Cherries, Radishes, and Watermelon

 Caraway seeds, tomato soup, and eggs
 Chicken, grapes, and raspberries
 Squash, Spinach, and Pickles

Cherries, Radishes, and Watermelon are gas causing foods and should be decreased in
consummation if a patient is experiencing excess gas.

3.) A patient is diagnosed with Congestive Heart Failure and must follow a specific diet. Which
spices are okay for the patient to use daily?
Obert G. Noble
BSN – 4 NB

 Onion Salt & Garlic Powder

 Ginger & Bay Leaves
 Sea Salt & Pepper
 Garlic Sodium & Nutmeg

Patients with CHF should avoid excessive sodium. All of the options expect one contain at least one
sodium spice, therefore, Ginger & Bay Leaves are okay to use.

4.) A patient with gout should follow what type of diet?

 High-calcium diet
 Potassium-modified diet
 Low-purine diet
 Renal Diet

Patients with gout suffer from elevated uric acid levels which can cause a gout attack. Therefore, they
need to restrict from eating foods high in purine. These foods usually include: anchovies, herring,
mackerel, sardines, scallops, glandular meats, wild game, goose, and sweetbreads.

5.) The patient is on a low potassium diet that includes food such as applesauce, green beans,
cabbage, lettuce, grapes, and raspberries. What type of patient would you expect to be on this
type of diet?

 A patient with heart disease

 A patient with osteoporosis
 A patient with Addison’s disease
 A patient who recently had gastric bypass surgery

Patient’s with Addison disease secrete too much potassium so they need to be on a low potassium
diet.