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David Bruce is a 49-year-old Native American man suffering from type 2 diabetes. Some healthcare providers have attended to him. However, the illnesses have not been effectively managed and treated. David had relatively healthy weight, but since he lost his secretarial job and started insulin medication, he has considerably increased weight, and he is now obese. He is 5 feet 8 inches (5'8") and weighs 210 pounds. His BMI is 32. The weight issues make it hard for him to secure a job or engage in any daily living activity. He does not exercise. As a teenager, David used to smoke but stopped smoking after joining the university. However, he takes huge amounts of alcohol. Besides, he does not take his insulin medication as required. He also socially isolates himself because he is embarrassed by his size and consequently he prefers to stay at home all alone, he does not even visit his children even if they live in the same state.
2. Pathophysiology of the Type 2 disease
Type 2 diabetes is a condition marked by both resistances in insulin and beta-cell dysfunction (Chew, Boon-How, and Aaron 796). This condition evolves due to ineffective use of insulin by the body. Insulin helps the body absorb glucose and use it for energy. According to Vijan, one develops insulin resistance if the body is improperly using insulin or not producing enough insulin. It occurs when cells like fat cells, muscle, and liver do not react to insulin. Due to the insulin resistance, the body is required to produce insulin at higher levels and if the body fails, this leads to Type 2 diabetes. Increased resistance to insulin and impairment of secretion of insulin are the key pathophysiological components of this type of diabetes and they both lead to the disease’s development.
The mass of the functional beta-cell keeps on decreasing, and this, therefore, makes type 2 diabetes to be a progressive disease. Different environmental factors together with genetic factors are the cause of the disease. Current change of lifestyles has also increased the number of those living with the condition. The failure of the body to produce insulin is associated with the low response of glucose. To be specific, when the postprandial phase secretion decreases, it leads to the pathophysiological condition. If the glucolipotoxicity is not treated, it lowers the functionality of the beta-cell mass. The objective of treating diabetes is securing a lifespan and a life quality which can be compared to the healthy people. The importance of doing this is to prevent its occurrence and development of vascular complications. There is, therefore, the need to initiate proactive intervention and also emphasize the need for comprehensive intervention in meeting this goal (Weyer 1933). This type of diabetes is a multifactorial illness which entails varying environmental factors and different genes.
Type 2 diabetes is more likely to develop in people aged 45 and over who are overweight, overeating, stressful, aging, non-active, having Type 2 diabetes in the family line or suffering from hypertension (Chatterjee, Kamlesh and Melanie 2247). Obesity is among those high-risk factors which are seen to aid development of diabetes, causing cells to become less receptive to insulin. Treatment is based on lifestyle modification such as losing weight, eating healthy and exercising. Individuals with Type 2 diabetes may worsen over time if they are not actively modifying their lifestyles. Therefore, from the point of diagnosis onward, individuals with Type 2 diabetes require psychological support to manage their condition. The psychological make-up of these patients plays a big part in the person’s willingness to self-manage the condition (Kahn, Rebecca, and Kristina 840). It is evident that people with this condition not only deal with the physiological conditions but with the psychological effects as well.
3. 24-hour nutritional history on David Bruce
180g wholegrain cereal
250 ml fresh milk
1 cup blue berries
200g high-fat yogurt
A, B-6, C, D, and E
A and C
A and E
4 slices bread
2 cup salad vegetables
B3, B5, B6, D
A, C, B3
B, omega 3
Calcium and iron
Calcium and iron
160g Coffee with milk
200ml salted nuts
B2 and B3
B12, A, C
Calcium and Iron
2 cups fried pumpkin
¼ cup steamed broccoli
4 steamed squash
2 tsp saturated olive oil
Magnesium, Phosphorus, and Calcium
4. Nursing Diagnosis
a. Is the patient getting appropriate calories?
The current intake of David’s calories per day is 3016. According to myplate.com, considering his age, weight, and height, he I supposed to consume 2200 Calories to achieve a healthy weight. Therefore, David is consuming far too many calories than expected.
b. Is the patient getting enough protein?
David is consuming 45.89g of proteins per day. This again is below the required range because as demonstrated by myplate.com, based on his age, his daily protein intake is supposed to be 6 ounce equivalents.
c. Is the patient getting adequate nutrition from all the food groups?
According to the nutritional history provided by David as shown in the table above, he is not getting adequate nutrition from all the food groups. His fruits intake was 75g higher compared to the recommended intake while his average intake of vegetables was less by 163g. Additionally, as seen from the table, David’s grain intake was significantly low. As mentioned above, he is also taking high amounts of calories compared to the required amount and his protein intake is far below the required amounts.
d. Is the patient deficient in any of the food groups?
As mentioned above, David is deficient in vegetables and proteins as his intake of these two groups is below the required amounts.
e. Is the patient deficient in any vitamins or minerals?
As shown in the table above, David is taking all the required vitamins and minerals
f. Teaching needs (health promotions) needed by David in relation to nutrition
For someone with diabetes, nutrition is the number one issue that needs to be addressed. When creating a care plan for David, the caregiver should focus more on a healthy diet. When planning and shopping for his meals, he should:
• Help him understand why he should not skip meals and how to control portions
• Exclude all refined sugar in his diet
• Avoid sodas and limit juices
• Add vegetables and fruits to the diet, the person taking care of him should bear in mind that, for a diabetic, not all fruits are created equal. For instance, avoid fruits which have too much sugar such as grapes and raisins. In addition, include certain green fruits: green apples have much less sugar compared to red ones; similarly, greenish bananas are better than deep yellow ones.
• Avoid fat and salt in cooking
The caregiver should also ensure that David has sugary items such as orange juice ready in case of an emergency.
Similarly, since insulin dries out the natural skin’s moisture, David should drink adequate water. He should always be hydrated and check skin for dryness. Exercise is also another way to keep diabetes under control; therefore, David should be encouraged to stay active.
g. How David can improve his nutritional status
For David’s well-being, he needs to make food choices that benefit his health. He needs to make a choice of foods that provide health benefits beyond their contributions of nutrients. If need be, modifications should be made on the foods in order to meet the recommended levels. Also, he may require adding phytochemicals or nutrients in order to get the health benefits (Moynihan and Poul 214). The main improvements which need to be done are:
1. David should increase the protein levels by use of protein supplements such as Whey. Whey is a significant supplement because it has all amino acids that are fundamental to the needs of the human dietary. Also, this is a convenient and easy source of high quality and complete proteins.
2. Similarly, David should add more whole grain products in his diet to boost the grain levels. Some of the widely available grains which he can consider include brown rice, corns, and oats.
3. Finally, David should increase his fluid intake by taking more water. Water has so many functions in the body: it assists in removing waste products, transporting nutrients to the cells, as well as maintaining homeostasis. Research shows that lack of enough water in the body causes dry skin, constipation, slowed metabolism, headaches, fatigue, and foggy thinking.
Chatterjee, Sudesna, Kamlesh Khunti, and Melanie J. Davies. "Type 2 diabetes." The Lancet 389.10085 (2017): 2239-2251.
Chew, Boon-How, Sazlina Shariff-Ghazali, and Aaron Fernandez. "Psychological aspects of diabetes care: Effecting behavioral change in patients." World journal of diabetes 5.6 (2014): 796.
Kahn, Steven E., Rebecca L. Hull, and Kristina M. Utzschneider. "Mechanisms linking obesity to insulin resistance and type 2 diabetes." Nature 444.7121 (2006): 840.
Moynihan, Paula, and Poul Erik Petersen. "Diet, nutrition and the prevention of dental diseases." Public health nutrition 7.1a (2014): 201-226.
Vijan, Sandeep. "Type 2 diabetes." Annals of internal medicine152.5 (2014): ITC3-1.
Weyer, Christian. "Hypoadiponectinemia in obesity and type 2 diabetes: close association with insulin resistance and hyperinsulinemia." The Journal of Clinical Endocrinology & Metabolism 86.5 (2016): 1930-1935.
White, Mathew. "Blue space: The importance of water for preference, affect, and restorativeness ratings of natural and built scenes." Journal of Environmental Psychology 30.4 (2015): 482-493.
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