Nutritional Assessment on a Medical-Surgical Patient
This paper aims to analyze a typical day’s diet at home of a 61-year female patient admitted at Mountain View Hospital for a back pain radiating to the left leg. This patient underwent a back surgery and developed surgical complications. Furthermore, this paper will compare the patient’s typical diet with the prescribed diet. Analyzing and comparing the client’s diet with the recommended follows and it will end with a plan for diet modifications.
Subject
The subject is a 61-year old Caucasian female. She is married and has two children. She works as a special education teacher at a local high school. She stands 5 feet and 9 inches tall and weighs 109.9 kg. Her BMI is calculated at 35.7.
Typical Day’s Diet
At home, she does not eat breakfast but drinks a glass of Arizona green tea zero calorie. For lunch, she eats a chicken salad sandwich, three small Mandarin oranges, a glass of Arizona green tea, and a cup of Chobani Coconut Greek Yogurt. For dinner, she eats one cheeseburger with one medium pack of french fries mostly purchased at burger joints like Burger King. She drinks a glass of Arizona green tea afterwards. Finally, after dinner she eats 2 cups of microwaved popcorn and drinks another glass of Arizona green tea. The patient expressed her dislike for drinking water that is why she drinks the green tea all the time.
Nutritional component of diet. Presented in a tabular form hereunder are the typical diet’s nutritional values.
Table 1. Nutritional Component for Diet
Food Calories Carbohydrate Protein Fat Sugar Dietary Saturated Sodium Potassium Calcium Iron Vitamin Vitamin
(Total) (% kcal) (%kcal) (%kcal) (g) Fiber(g) Fat (g) (mg) (mg) (mg) (mg) A(mg) C (mg)
Arizona
Green Tea 0 0 0 10
Zeroa (240ml)
Chicken sandwich
2 slices large white
Breada 159 10 14 3 1.6 295 156 2 30
½ cup rotisserie
seasoned chicken
salada 210 1 13 23 6 2 640 <1 2
Mandarin
Oranges,
Smallb 40 3 1 0 8 1.4 1.5 126 28 <1 517 20
Coconut
Greek
Yogurtc 150 40 32 27 12 <1 3.5 50 200 130
Cheese
Burgerb 280 39 21 42 7 6 560
French
Fries,
Mediumb 380 56 5 40 4 570
Popcorn,
Cooked
2 cupsa 70 34 0 6 110
Data from: a: (Calorie King, 2019); b: (Nutrition Value, 2019); c: (Chobani, 2019)
Medical diagnosis and prescribed diet
Patient is diagnosed with gastrointestinal bleed S/P descending colon resection due to bowel injury from a lumbar discectomy related to annular tear of lumbar disc. At the time of patient interaction, she was on her fourteenth post-operative day. She is already on regular diet with no dietary restriction.
Regular diet is designed for the maintenance of ideal nutritional status in those that do not require dietary modifications. This diet minimizes the “risks for chronic diet-related diseases such as cardiovascular diseases and certain cancers (Grodner, Escott-Stump, & Dorner, 2016, p. 264).”
Compare/Contrast
Table 2 below shows the comparison of the patient’s dietary intake versus the recommended daily allowance for age and gender. It can be inferred that the patient consumed less on most of the recommended total daily allowance. Protein and fat are within the recommended while the patient is trailing behind on her intake of carbohydrates, minerals, and vitamins.
Table 2. Comparison of patient’s diet with recommended daily allowance
Nutritional component
Patient’s diet
RDA female 51+ (a)
Calories
1369
1600
Protein, % kcal DV*
15
10-35
Carbohydrate, % kcal DV*
27
45-65
Total fat, % kcal DV*
24
20-35
Sodium, mg
2240
2300
Potassium, mg
Zinc, mg
578
0
4700
8
Iron, mg
<4
8
Calcium, mg
Vitamin A, mg
Vitamin B6, mg
Vitamin B12, mcg
Vitamin C, mg
Vitamin E, mg
Thiamin, mg
Riboflavin, mg
370
1581
0
0
62
0
0
0
1200
700
1.5
2.4
75
15
1.1
1.1
Data from (a): 2015-2020 Dietary Guidelines for Americans
* DV: Daily Value
Modification
Based on the gathered data, her diet falls short from the recommended and considering her surgical complication thus she is at risk for malnutrition. Her prolonged hospital stay coupled with slower progress in recovery could probably due in part to her diminished nutritional state. Therefore, a more in-depth analysis and assessment of her nutrition by a registered dietitian is highly recommended. As recommended by MyPlate, she needs to eat a variety of food from each food groups (Grodner et al., 2016). She especially needs to eat more fruits and vegetables since she is missing a lot of the vitamins and minerals provided by these food groups. Vitamins and minerals are important in wound healing. CDC recommends consumption of 2 to 6.5 cups of fruits and vegetables each day (Grodner et al., 2016). It is also important to encourage the patient to drink water. Diet modification is not easy for anybody. To convince patients to change their diet, nurses must provide appropriate patient education with clear explanations and rationale on why a diet needs to be modified.
Conclusion
The assessment of the nutritional status through analysis of a patient’s typical diet and comparing it with the recommended is an important first step in the identification of those patients at nutritional risk while admitted. Knowing the nutritional risk is an invaluable tool in predicting the outcome and full recovery of a patient. Grodner et al. (2016) noted that “the capacity for recovery from illness or disease depends heavily on nutrition status. (p. 259).”
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Grodner et al. (2016) also discussed that hospitalization is stressful enough that it could ruin one’s nutritional status. Undergoing various tests, surgical procedures, taking multiple medications, the frequent interruptions from hospital staff, and the illness itself are stressors that can all result to a decrease in nutritional intake. If the patient’s nutritional status is already compromised to start with, the consequences will be greater. In a study done by Mignini et al. (2018), out of the fifty patients that underwent major surgeries 54% had a compromised nutritional status. These patients with poor nutritional status had poorer stress response after the surgery. The authors suggested that recognizing patients who are potentially at risk of surgical complications through nutritional status assessment is important so that early nutritional interventions could be planned.
References
Calorie King. (2019). Retrieved from https://www.calorieking.com/us/en/foods/f/calories-in-breads-white-bread/MYdVDzj5TemqsaeIZiyMNw
Calorie King. (2019). Retrieved from https://www.calorieking.com/us/en/foods/f/calories-in-popcorn-movie-theater-butter-popcorns-popped/m69gFArNTeunXZAgHYyaQQ
Calorie King. (2019). Retrieved from https://www.calorieking.com/us/en/foods/f/calories-in-salads-deli-salads-chicken-breast/Up39OkQUQwWmyKxGADz3wA
Calorie King. (2019). Retrieved from https://www.calorieking.com/us/en/foods/f/calories-in- teas-diet-green-tea-with-ginseng-honey/CZS1__XIQa2O7P16LewbVQ
Chobani. (2019). Retrieved from https://www.chobani.com/products/blended/cup/coconut/?gclsrc=aw.ds&
Grodner, M., Escott-Stump, S., & Dorner, S. (2016). Nutritional foundations and clinical applications. St. Louis, MO: Mosby.
Mueller, C., Compher, C., & Druyan, M. (2011). Nutrition screening, assessment, and intervention in adults. Retrieved from https://onlinelibrary.wiley.com/doi/pdf/10.1177/0148607110389335
NutritionValue.org. (2019). Retrieved from https://www.nutritionvalue.org/Tangerines%2C_raw%2C_%28mandarin_oranges%29_nutritional_value.html
U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015). 2015–2020 Dietary guidelines for Americans. Retrieved from https://health.gov/dietaryguidelines/2015/guidelines/appendix-2/
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