Dionisio
BS Nursing
Gerald was a 30-year-old African American man who had been a paraplegic for five years. He
lived in a house with his three brothers, who helped take care of him. John did the cooking. He
made fried eggs, grits and bacon, and coffee for breakfast. Pork and potatoes with greens were a
typical dinner. Gerald didnt like milk; it gave him gas.
Gerald loved to play wheelchair basketball with the neighborhood kids. He would have his boom
box blasting on the side of the court and play for hours. The kids loved the attention, and Gerald
loved to be outside. During the school year, Gerald took classes at the local college and tried to
sell his drawings to any admirer. He felt most alive when he was just wheeling around the
neighborhood in the warmer months. Gerald was no good at limiting the amount of time he was
in his chair. He was even worse at staying in bed, off his buttocks. He had a tendency to
develop pressure ulcers. This time Gerald had the worst problem yet. His doctor said he had to
go into the hospital for skin flap surgery to close the decubiti. He would have to stay off his back
at least three weeks, possibly more, until the incision lines had healed. Gerald could not smoke in
the hospital. The doctor was willing to let him use a nicotine patch if needed.
Initially, Gerald did well after surgery. He made the transition to regular food. Within two weeks,
he was complaining of dry, itchy skin, and the doctor was worried about his five-pound weight
loss. The provider ordered a dietary assessment.
ASSESSMENT
- Dietitian, home health care nurse, social worker, own family, significant others.
- Self motivation
15.If Gerald is unable to eat enough food to maintain his weight, what alternatives does the
doctor have?
- Tube feeding, total parenteral nutrition food supplements; involve the dietitian
EVALUATION/OUTCOME CRITERIA
17.What criteria will the doctor use to determine if the plan is effective?
- Daily weight
THINKING FURTHER
18.How are Geralds needs similar to those of any other surgical client?
19.What are the most serious consequences if Gerald is unable to heal, even with tube
feedings?
The dietitian met with Gerald to discuss how to incorporate more protein into his diet. Gerald is
trying to teach his brother John, the cook. What do you think of the meal that Gerald has
planned? Figure how much protein Gerald has planned in his meal.
6 oz sirloin steak