NCP Report 4

Diabetes
Patient 4
I.

II.

Introduction: Patient Profile

Patient 4 is a 61 year old Caucasian female. Pt is diagnosed with PTSD,
unspecified psychosis, and COPD. Pt is diagnosed with the following nutrient-related
diseases: insulin dependent diabetes, foot neuropathy, and obesity.
Disease Process
Diabetes mellitus is the most common endocrine system disorders in todays
society. It affects over 25.6 million individuals in the United States. There are diverse
forms of diabetes: type I (destruction of beta-cells with absolute insulin deficiency),
type II (progressive defective insulin secretion with insulin resistance), gestational
diabetes (diabetes diagnosed during pregnancy), and prediabetes (impaired fasting
glucose or impaired glucose tolerance). Hyperglycemia is a result from all forms of
diabetes. Hyperglycemia is correlated with organ dysfunction and damage,
progressing to failure of numerous organs, particularly the eyes, kidneys, nerves,
heart, and blood vessels.
Type 2 diabetes mellitus (T2DM) is most commonly diagnosed in adults but
recently is being diagnosed among children and adolescents. Other risk factors
associated with T2DM are obesity, family history, history of gestational DM,
impaired glucose metabolism, and physical inactivity. Android adiposity seems to
increase the degree of insulin resistance. T2DM occurs when there is a combination
of abnormal insulin secretion and insulin resistance. Individuals diagnosed with
T2DM produce insulin but their tissues are insulin resistant. This increases the need
for insulin, so the pancreas increases production. However, the pancreas is not able to
maintain such high insulin production levels.
There are several risk factors associated with T2DM. They include the following:
hyperglycemia, dawn phenomenon (overnight release of hormones), ketoacidosis,
hyperglycemic hyperosmolar syndrome, mild hyperglycemia, severe hyperglycemia,
cardiovascular disease, nephropathy, retinopathy, peripheral neuropathy, and
autonomic neuropathy.
Nutrition therapy for diabetes is individualized. There needs to be a
comprehensive assessment, a self-care treatment plan, and pts health status, learning
ability, readiness for change, and current lifestyle should be the foundation of
nutrition therapy. Intervention for diabetes is individualized as well, there is no one
diabetic diet. Nutrition education is the basis to understand the food- and nutritionknowledge deficit. The primary goals for nutrition therapy are the following:
HbA1c <7%
Blood pressure < 140/80 mmHg
LDL cholesterol <100 mg/dl; triglycerides <150 mg/dl; HDL cholesterol
>40 mg/dl (men); HDL cholesterol >50 mg/dl (women)
Achieve and maintain body weight
Delay or prevent complications of diabetes

Nutrition prescription should be based on an individuals eating pattern,

preferences, and metabolic goals. The general foundation for macronutrient
distribution for diabetes is: 45% kcals from carbohydrates (fruits, vegetables, wholegrains, legumes, and low-fat dairy products are highly encouraged) and <30% kcals
from fat.
III.

Patient History
Pt 4 has history of suicidal thoughts and auditory hallucinations. She stated that 2
weeks ago she cut herself. Pt 4 has a history of uncontrolled diabetes. Pt is having
glucose tested 4 times daily.

IV.

Course of Hospital Treatment

N/A

V.

Nutrition Care
a. Assessment
Weight: 285 lbs = 129.54 kg
Height: 54 = 64
BMI: ((285)/(64)(64))x703= 48.9 kg/m2 Extreme obesity class III
IBW: 100+(5x4)= 120 lbs
%IBW: 285/120= 237.5%
AdBW: 0.25(285-120)+120= 161 lbs = 73.3 kg
Lab Values
Lab
Normal Levels
Results
Na+
133-145 mmol/L
135
Potassium
3.5-5.0 mmol/L
3.7
Glucose
70-105 mg/dl
169
BUN
4.0-25.0 mg/dl
13.0
Creatinine
0.5-12.0 mg.dl
0.83
Ca
8.5-10.4 mg/dl
9.0
Albumin
3.10-4.70 g/dl
4.0
Total Protein
6.6-8.2 g/dl
7.7
Hb
10.9-16.0 g/dl
15.4
Hct
33.0-47.0 %
47.0
Alk Phosphate
38-132 U/L
81
Drugs
Drug
Depakote
Desyrel
Glucophage
Milk of magnesia
Neurontin
Nicoderm

Reason
Mood Disorder
Sleep
Diabetes type 2
Constipation
Neuropathy
Nicotine withdrawal

Interaction with Food

Do not drink alcohol
Take with food
Do not drink alcohol

Novolin (100 units)

Prozac
Risperdal
Tylenol

Diabetes type 2
Mood Disorder
Psychosis
Pain/fever

Increases appetite

Nutrient Needs
o Kcals: 73 kg x 30 kcals= 2190 total kcals
o Protein: 73kg x 1g= 73 g PRO
o Fluids: 73 kg x 30 cc= 2190 cc

b. Diagnosis (PES) Statement

Potential risk for complications of hyperglycemia relates to diabetes dx as
evidenced by elevated fasting blood glucose lab value of 169, foot
neuropathy dx.
Obesity related to inadequate energy intake as evidenced by BMI of 48.9
kg/m2, visual evaluation.
Dx of diabetes related to altered nutrition-related laboratory values as
evidenced by elevated glucose levels of 169.
Food- and nutrient-related knowledge deficit related to mental status as
evidenced by dx of PTSD, psychosis.
Self-monitoring deficit related to mental status as evidenced by dx of PTSD,
psychosis.
Obesity related to physical inactivity as evidenced by BMI of 49 kg/m2, visual
evaluation.
Inability or lack of desire to manage self-care related to peripheral neuropathy
as evidenced by medical records.
c. Intervention Plan & Implementation
Pt 4 will lose 1-2 lbs per week while consuming an 1800 calorie restricted diet. Pt
will increase physical activity to 30 minutes per day with progression to 60
minutes per day. Pt will receive nutrition education one day a week to understand
how to monitor and control diabetes.
d. Monitoring/Evaluation
Will continue to monitor weights, fasting blood glucose levels, HbA1c levels,
physical activity, and energy intake.
e. Documented
Completed.