Name: Samantha Brown

Score:____________________

Case Study Assignment Nelms Case # 18

NUTRITION ASSESSMENT
1. Using assessment parameters available in this case study, list the 4 top or most pressing issues
in the first column. In the 2nd column provide justification of this concern by recording the
analysis or assessment of data.
Nutritional issue/concern
Food and Nutrition Related Knowledge
deficit (NB-1.1) 1

Obesity (NC-3.3) 1

Inadequate Fluid Intake (NI-3.1) 1

Inconsistent Carbohydrate Intake (NI5.8.4) 1

Assessment data or analysis to justify problem

Patient has never seen anyone for diabetes teaching
beyond what his physician has told him. He does not
understand importance in taking his medications
regularly. Patient reports of inconsistent carbohydrate
intake leading to uncontrolled diabetes. Blood
glucose level and A1C significantly higher than
normal.
Patient has a BMI of 31.6 and 133.75% IBW.
Obesity leading to fat in the liver is thought to
contribute to insulin resistance. Loss of weight may
help to decrease insulin resistance. 2
Patient reports of excessive vomiting. Patient has
possible HHS evidenced by drowsiness, dry mucous
membranes in throat, warm/ dry skin with poor
turgor, rapid respiration, yellow cloudy urine, and
low sodium levels and phosphate levels.
Patient reports of varying meal choices and healthier
choices at home. Does not adhere to a certain amount
of carbohydrates at each meal and snack. Lab data
show patient has blood glucose level of 475 mg/dL
and hemoglobin A1C 11.5%.

NUTRITION DIAGNOSIS
2. Based on the nutrition assessment, identify the highest priority problem (once the Mr. Fagen
is properly hydrated) from question #1 and write the PES statement.
Food and Nutrition Related Knowledge Deficit (NB-1.1) 1 (P) related to no previous diabetic
nutrition education (E) as evidenced by patient reporting no previous nutrition education,
inconsistent carbohydrate intake, failure to take prescribed medication, and raised blood glucose
and hemoglobin A1C levels. (S)
NUTRITION INTERVENTION

3. Identify a nutrition care plan for Mr. Fagan to follow after he leaves the hospital to address the
problem identified in #2. Provide a goal(s) and corresponding intervention(s) in the labeled
columns in the table below using short but clear statements. The goal and interventions should
target the etiology of the problem. You may have more than one goal or just one goal but
several intervention strategies to achieve that goal if so, clearly identify which strategies go
with which goal by numbering the strategies adjacent to the corresponding goal so it will be
clear to the reader.
Problem from
question # 2 (PES)

Overall Goal/prescription

Food and Nutrition

Related Knowledge
Deficit (NB-1.1) 1

Nutrition relationship to
health/disease (E-1.1) 3
Patient understanding importance
of consistent carbohydrate and
medication intake
Patient understanding of
carbohydrate serving sizes and
healthy meal options

Intervention strategies to meet the

goal; actions and recommendations
to be taken (based on the etiology
in the PES statement)
Provide Nutrition education
regarding consistent carbohydrate
intake, servings sizes, and healthy
meal options.
Use diabetes education resources
with pictures to show serving sizes.
Emphasize importance of
carbohydrates from nutrient dense
foods in appropriate portion sizes
such as fruits, vegetables, whole
grains, legumes, and low fat milk.
Monitoring carbohydrate though
counting, exchanges or experienced
based estimation is a key strategy,
grade A, in achieving glycemic
control. 4
Educate on importance of taking
medication as well as side effects of
not taking it.
Recommend further counseling for
lifestyle change behavior including
physical activity and/or a 250-500
k/cal deficit per day to promote
weight loss.
Physical activity improves glucose
control, reduces cardiovascular risk
factors, and improves well-being. 5

NUTRITION MONITORING AND EVALUATION

4. Identify the means of evaluating and monitoring the intervention(s) you have outlined above.
Provide specific indicators and/or parameters that can be used to determine effectiveness.

Intervention from
question # 3
Provide Nutrition
education regarding
consistent carbohydrate
intake, serving sizes, and
healthy meal options.
Educate on importance of
taking medication as well
as side effects of not taking
it.
Recommend further
counseling for lifestyle
change behavior including
physical activity and/or a
250-500 k/cal deficit per
day to promote weight loss.

Indicators/parameters utilized to
evaluate effectiveness of
intervention (related to signs and
symptoms)
Assess knowledge of the
importance of a healthful diabetic
diet and a full understanding of
serving sizes. Assess knowledge
of the importance of taking
prescribed medications daily and
associated health risk.
This can be done through
questioning of knowledge and
dietary/ medication intake recall.

When how often to be

evaluated
Once a month for the first 5
months, for a total of 5 visits.

Assess serum glucose laboratory

results to check if they have gone
down, as well as A1C levels over
time.
Assess food, beverage and
nutrient intake, serving sizes,
meal-snack patterns and
carbohydrate intake. 6
This can be done through intake
diary.

5. Combine the above 4 steps and write a nutrition notation according to the Nutrition Care
Process using ADIME. Include the Nutrition Assessment, Nutrition Diagnosis, Nutrition
Intervention, and Nutrition Monitoring and Evaluation. The total note should not be longer
than page (4-5 lines per step).
Nutrition Assessment
Age: 53; Gender: M
Health History: Type 2 diabetes, HTN, hyperlipidemia, gout
Family History: HTN and type 2 diabetes
BMI: 31.6 obese; 133.75% IBW
Estimated Nutritional Needs: 2,300 k/cal 78-97 g protein/ day
Nutrition Diagnosis
Food and Nutrition Related Knowledge Deficit (NB-1.1) 1 (P) related to no previous diabetic
nutrition education (E) as evidenced by patient reporting no previous nutrition education,
inconsistent carbohydrate intake, failure to take prescribed medication, and raised blood glucose
and hemoglobin A1C levels. (S)

Nutrition Intervention
Provide Nutrition education regarding consistent carbohydrate intake, serving sizes, and healthy
meal options.
Educate on importance of taking medication as well as side effects of not taking it.
Recommend further counseling for lifestyle change behavior including physical activity and/or a
250-500 k/cal deficit per day to promote weight loss.
Monitoring and Evaluation
Monitor and evaluate once a week for first 3 months, then once a month for next 3 months.
Assess knowledge of the importance of a healthful diabetic diet and a full understanding of
serving sizes. Assess knowledge of the importance of taking prescribed medications daily and
associated health risk.
Assess serum glucose laboratory results to check if they have gone down.
Assess food, beverage and nutrient intake, serving sizes, meal-snack patterns and carbohydrate
intake.
References
1. American Dietetic Association. Nutrition Care Manual. Nutrition Diagnostic Terminology.
https://www.nutritioncaremanual.org/vault/IDNT%20e3%20NDTerms-NCM.pdf. Accessed
November 14, 2016.
2. Tredts E, Wasserman DH, Williams AS. Integrated Physiology/ Obesity. Diabetes. 2016;
65(Supplement 1): A463-464.
3. American Dietetic Association. Nutrition Care Manual. Nutrition Intervention Terminology.
https://www.nutritioncaremanual.org/vault/IDNT%20e3%20NITerms-NCM.pdf. Accessed
November 15, 2016.
4. Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, Neumiller JJ,
Nwankwo E, Verdi CL, Urbanski P, Yancy WS Jr. Nutrition Therapy Recommendations for
the Management of Adults with Diabetes. Diabetes Care. 2014; 37(Supplement 1): S120S143.
5. Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, Horton ES,
Castorino K, Tate DF. Physical Activity/ Exercise and Diabetes: A Position Statement of the
American Diabetes Association. Diabetes Care. 2016; 39(11): 2065-2079.
6. Academy of Nutrition and Dietetics. Evidence Analysis Library.
http://www.andeal.org/tmp/prn2F234964467AC8144F2C614DEB0DF456.pdf. Diabetes
(DM) Type 1 and 2: Monitor and Evaluate Effectiveness of Medical Nutrition Therapy.
Accessed November 16, 2016.