Once Esther’s dehydration was corrected and her oral intake improved, she was discharged home under the care of her family. Unfortunately, her mental status continued to decline. Esther now needs assistance with activities of daily living (primarily cooking food and climbing stairs). After 3 weeks, Esther was readmitted with failure to thrive and dehydration; she had lost an additional 5 pounds within a month. She appears very weak, at times incoherent, and is not responding appropriately to your questions.
Anthropometric Data:
Height: 152.4 cm (60”) Weight: 38.5 kg (85 lbs) BMI: 16.6 kg/m2
Biochemical Data:
Sodium 152 (135-145 mEq/L) Glucose 88 (70-139 mg/dL) Potassium 3.0 (3.6-5.0 mEq/L) Hematocrit 33 (35% to 47%) Chloride 111 (98-110 mEq/L) Hemoglobin 12 (12.0-15.5 gm/dL) Carbon dioxide 24 (20-30 mEq/L) Albumin 3.4 (3.5-5.0 g/dL) Blood urea nitrogen 40 (6-24 mg/dL) Mean corpuscular volume 118 (80-99 fL) Creatinine 2.8 (0.4-1.3 mg/dL)
Clinical Data:
Vital signs: Blood pressure: 95/72 mm Hg Medications: Atenolol, Protonix, Seroquel, Os-Cal, vitamin B12, NSAID
Dietary Data:
Dietary History: Family states that Esther continues to have a poor appetite. She reports some difficulty swallowing and frequently coughs after drinking fluids. Once a week they take her out to eat at her favorite restaurant where she eats 100% of her meal of fish, mashed potatoes, and carrots.
1. What is Esther’s current nutritional status? How has it changed?
2. Assess her biochemical indices. What are your concerns?
3. How does her medical history and overall health impact her nutritional risk?
4. Would you recommend adding or deleting anything to her medication regimen?
5. What should be considered when developing nutrition interventions for Esther?