3.7 Learning Activities

Healthy Diets Case Study^[1]

Mrs. Fatima Khan is an 86-year-old female is hospitalized with generalized weakness and signs of malnutrition. She has a history of coronary artery disease and reports recent unintentional weight loss of 15 lbs, generalized weakness, loss of appetite, and difficulty chewing. She also reports she tires easily when performing ADLs. On assessment, she is alert and oriented, but weak. Her skin is dry and flaky with reduced subcutaneous fat, and her mucous membranes are dry. Current vitals: BP 134/68, HR 74 bpm, RR 22 bpm, Temp 97.6 F, and O2 Sat 95% on room air. Speech therapy consult has been placed for evaluation for swallowing difficulties.

Provider Orders

Significant Lab/Diagnostic Results

 Progress Notes

• 1100: Patient admitted to the medical-surgical unit with malnutrition. Blood samples drawn for CBC, BMP, and albumin. Dietary consult placed for nutritional assessment and recommendations.
• 1315: Patient consumed 25% of lunch. Reports feeling fatigued and having difficulty finishing meals.
• 1500: Speech therapist consulted to evaluate patient’s swallowing difficulties and make recommendations.
• 1730: Patient reports dentures are ill-fitting and contribute to chewing difficulty. Patient provided with oral care.
• 1800: Patient consumed 30% of dinner. Continues to report fatigue.

Critical Thinking Questions

1. Upon initial assessment of Mrs. Khan, which of the following findings is most important for the nurse to report to the provider?
   1. Serum albumin 2.8 g/dL
   2.  Oxygen saturation 95% on room air
   3. Heart rate 80 bpm
   4. Reports of fatigue
2. The nurse identifies that Mrs. Khan is at risk for several complications related to malnutrition. Which of the following complications should the nurse prioritize in the plan of care?
   1. Falls
   2. Constipation
   3. Urinary tract infection
   4. Delirium
3. Based on Mrs. Khan’s current condition, which nursing intervention is most important for the nurse to include in the plan of care?
   1. Implement strict intake and output monitoring
   2. Administer oxygen therapy as needed
   3. Encourage socialization during mealtimes
   4. Provide frequent reorientation to time and place
4. The nurse recognizes that Mrs. Khan’s laboratory results are consistent with which condition(s)? Select all that apply.
   1. Dehydration
   2. Iron-deficiency anemia
   3. Malnutrition
   4. Renal failure
5. Which of the following findings indicates that the interventions for Mrs. Khan have been effective?
   1. Mrs. Khan consumes 50% of her breakfast tray.
   2. Mrs. Khan’s serum albumin remains the same.
   3. Mrs. Khan’s oxygen saturation is 96% on room air.
   4. Mrs. Khan requires one nap during the day.
6. The nurse is working with a nursing assistant to provide care for Mrs. Khan. Which of the following tasks can be safely delegated to the nursing assistant?
   1. Provide education to Mrs. Khan about increasing protein intake.
   2. Assess Mrs. Khan’s swallowing ability during mealtimes.
   3. Assist Mrs. Khan with ambulation to the bathroom.
   4. Evaluate the effectiveness of current interventions for malnutrition.

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