Name: Maeve O ‘Donoghue Student Identification Number: 17277256 Course Title: BSc General Nursing Module code: NS4211 Module title: Nutrition for Nursing Practice Assignment title: Case study assignmentModule Leader: Liz Kingston Date of Submission: 29th of November 2019 Word Count: 2000 words +/- 10% DECLARATION OF ONE’S OWN WORK I, the undersigned declare that this assignment which I am submitting to the Department of Nursing and Midwifery, University of Limerick has been solely conducted and presented by myself. I have acknowledged and referenced all sources (published or otherwise) within this assignment. Print Name: ___________________________ Signature: ____________________________ Date: _____________________ Case Study PresentationIntroduction: Nutrition can be defined as one of life basic needs to survive. Nutrition is defined as the study of the nutrients in the food we eat, and how our body can use them nutrients in order to maintain a healthy diet, free from disease and good health. We can receive nutrition in many different methods such as supplements, nasogastric tube, PEG (percutaneous endoscopic gastrostomy) and special diet such as texture diet. (Butler et al,2017)This assignment is based on a patient who I cared for whilst being out on clinical placement for four weeks. My reasoning for basing my case study on this patient, is because she has altered nutrition status due to having type 2 diabetes. Only for being out on clinical placement, I have noticed how having diabetes plays an effect on people’s activities of daily living (ADL’s). (Fahey, 2018) I feel diabetes is on the rise, in comparison to previous years. About 90% of the adult population have type 2 diabetes. (Health Service Executive, 2018)The patient I have chosen to complete my case study on is a woman for suffers from type 2 diabetes. Her nutrition is altered as she controls her blood sugar levels by using a diabetic diet control. Nutrition is also altered as the patient is admitted into the hospital due to a day procedure she is having, which a colonoscopy. This patient is also fasting due to the procedure.The hospital I completed my case study in was an acute General Public Voluntary Hospital. It is a Charity under the Charities Act. The hospital has 99 beds which includes 89 inpatient beds and 10-day beds. (Health Service Executive, 2019) This hospital specialising in general medicine, surgery and gynaecology. Also has a local injuries unit and medical assessment unit. The ward I was on was the Surgical Day ward, which had 10-day beds. Procedures carried out in the included gynaecological, pain management, endoscopy, oral and maxillofacial and gastroenterology. (Health Service Executive, 2019)My case study will be divided into four subsections which include patient status, nutritional status, nutritional care plan analysis and recommendations. Patient Status: This patient is 55 years and 8 months, she is female. Her previous medical history includes the following type 2 diabetes (recently diagnosis), anxiety, and hypertension and is an ex-smoker as well as ex drinker. This patient previous surgical history hysterectomy in 2013. This patient has experience weight loss as of recent, which was unexpected weight loss.Current admission details, this woman was admitted on to the surgical day ward. This patient is due to have a procedure called a Colonoscopy. Which is a camera or scope that allows the consultant to view the colon also known as the large intestine. (O’Brien, 2019) How a patient prepares for a colonoscopy and things the doctor may have asked this patient to do, include a special diet before exam especially any red colour solids or fluids as it can be mistake for blood, take laxative, medications may need to be adjusted for example is a patient diabetic or suffer from hypertension as iron may be present in the medications or if they are on blood thinners such as Warfarin, as it can cause excessive amount of bleeding if a biopsy was being taken. (Mayo Clinic, 2019)This patient had completed the required bowel preparation before procedure which is called Moviprep. Moviprep also known as a laxative solution in which a patient drinks the night before surgery or procedure, in order to stimulate the bowel, it flushes the bowel out. So, the consultant can get a better image of the colon. (Drugs.com, 2019)The patient already had an altered nutrition due to having a diabetic diet. But as the patient was also have a procedure, we need the patient be fasting prior to procedure. Patient was fasting since 15:00pm the day before procedure. Patient should be nil by mouth up to 6 to 8 hours before surgery to prevent aspiration, pneumonia and reflux. (O’Brien, 2019) Prior to this type of procedure the local policies and procedures of this hospital also require that a patient who is getting a colonoscopy. Must be also on a low residue diet as it helps to avoid food being left in the bowel after it is digested and absorbed e.g. Cornflakes. (Health Services Executive, 2019) The reason behind this patient’s current admission a change in bowel habit, diarrhoea, constipation, pain abdominal area and unexpected weight loss. Which is a symptom to be expected with type 2 diabetes. (WebMD, 2019) The diagnosis for this patient was diverticulosis and the presents of several polyps. Diverticulosis forms due to pressure in the colon. Which then causes areas of the colon to weak and then wall of colon to bulge out and forms little sacs. (ASCRS, 2019) The treatment that is mainly of a dietary treatment plan. This patient was encouraged to engage in a high fibre diet. Which includes brake flakes, wholegrain rice and pasta, increased volume of vegetables. As this will help with the constipation problems and will avoid stool getting stuck in the sacs cause by diverticular disease and prevent infection forming. (Brooker et al, 2011)This patient has no know allergies. The current medication in which this patient is on are Clonidine Hydrochloride 75mg twice daily for hypertension, Metformin Hydrochloride 500mg twice daily for Type 2 diabetes and Diazepam 10 mg daily for anxiety. (BNF, 2019) Nutritional Status: This patient’s height is 5 ft. 5inches/ 1.65 meters. Her weight was 7 stone 7 pound/ 48kg. This patients BMI (Body Mass Index) was calculated as 17.6, which is considered to be underweight was a woman of her height. BMI helps us to see if a patient is a health weight for the height the patient is. BMI is also helpful as a screen tool, helps if a patient is at risk of developing heart disease, cancer or diabetes due to weight. (American Cancer Society, 2019) Underweight is to be a BMI under 18.5, normal weight is to be a BMI ranging from 18.5 to 24.9, overweight BMI ranges from 25 to 29.9 and obesity BMI ranges from 30 or more. (American Cancer Society, 2019)The physical appearance of this patient was she was extremely red and aged skin due being a previous smoker. She was breathless upon physical excretions due to being an ex-smoker/drinker and hypertension. She looked flushed. And her general self-esteem of this patient was low. As she was unable to participate in daily tasks e.g. Physical exercise, as she was in a lot of abdominal pain. The skin condition of the patient was good. The appearance of skin good, visible red around the face due to previous excessive smoking and consuming of alcohol. Skin condition I looked to see if there were any signs of redness, inflammation, oedema, cyanosis, rashes and looked at the skin integrity after the procedure. (O’Brien, 2019) There was no signs of any skin condition present. The patient was encouraged to frequently reposition them after the procedure to prevent any skin breakdown or pressure ulcers. Nutrition support that was given to this woman was a healthy diet, following a strict diabetic diet and high fibre diet. She was also referred on to the dietitian and her doctor to set up a strict eating plan that works well for her. According to the HSE participation in a healthy diet can prevent type 2 diabetes by 80%. (Health Service Executive, 2019)A healthy diet was put in place for this patient, which is a combination of many types of food for each different group in the food pyramid, it put in place to make sure this patient gets all the correct nutrients into her body to ensure she maintains a more health weight. This will help to prevent heart disease and some type’s cancer. (Safe Food, 2019) It was partial important for this patient to engage in a stricter diabetic diet in order to monitor her blood sugars. This received education and a support leaflet before being discharged. This leaflet guides the patient in the right steps. Steps include maintain a healthy weight, regular exercise, have 3 meals daily, eating fish which is oily, eating starch food which will also help with the patient’s high fibre diet, reduce sugar in diet, increase vegetables and fruit consummation at minimum five portions each day and reduction in fat intake. (Health Service Executive, 2014) This patient was also encouraged to engage in a high fibre diet. Some of which include brake flakes, using wholegrain items of food and this helps with the bowel movement. (Brooker et al, 2011) This patient was also encouraged to increase her fluid intake and it will help with her constipation problem and will prevent her from becoming dehydrated, as this is a common problem that can occur with patients with diabetes. Nutritional Care Plan Analysis: There is no current nutritional care plan for this patient. The reasoning behind no current nutritional care plan is because this patient was a day patient. This patient was receiving a procedure in the hospital without staying in hospital overnight.For this procedure of a colonoscopy the relevant information we need is a copy of the medications the patient is on, reason for referral for the colonoscopy, any known allergies and medical and surgical history. We received no information about previous nutritional care plan of this patient. As there was previous no care plan of nutritional needs set up. The now current nutritional care plan of the plan is as follows this patient is to engage in a healthy diet, to have a strict diabetic diet in place and also a high fibre diet too. She is also to increase her fluid intake. She has been referred on to a dietitian to monitor her nutritional care plan as well as her doctor.My evaluation behind this care plan was it was good that the patient was discharged with the relevant information need to improve her weight, health and diet, a positive effect. A negative effect was the patient hadn’t received adequate information regarding her diet previous to her hospital visit. She should have frequent visit to her dietitian in order to keep her on a good plan. Recommendations: My thought behind this case is, I recommend this patient should get involved more with her dietitian in order to help her to set up a proper nutrition and diet care plan. She should be referred to her dietitian. If this fails to help to get this patient to a health weight, I recommend that the patient may need supplements in order to increase her weight, as she would be at risk of developing pressure ulcers. Supplements such as forticreme, cubitan, fortslip or diasip.We can also use screening tools such as the Waterlow Score and M.U.S.T in order to help prevent this patient becoming malnourished or prevention of pressure ulcers. These can be use often to prevent this occurring. I also recommend that this patient may getting involved in support groups regarding proper nutrition needs and the importance of nutrition. I recommend the use of the Multi – Disciplinary Team (MDT)in order to help this patient to a healthy diet and lifestyle. In this module for nutrition we learn about the aspect of who is involved in the nutrition care of a patient. It is not just the nurse, but it is the MDT as a unit. (Kingston, 2019) I would involve the MDT in order to manage this woman altered nutrition and to insure all the MDT are catering from this patient nutritional needs. e.g. dietitians provide education, nurse use screening tools.The use of the nursing process in order help to insure all needs of patient were catered from assessment, plan, implement and evaluate. Conclusion: In this assignment, I have reflected upon the patient status, nutritional status, nutritional care plan analysis and made recommendations to a patient who had an alerted nutritional status. Reference ListHealth Service Executive (2018) Diabetes Type 2, available: https://www.hse.ie/eng/health/az/d/diabetes,-type-2/ [Accessed 1 November 2019]Health Service Executive (2019) Health Service Executive, available: https://www.stjohnshospital.ie/management-and-admistration/welcome-to-the-st-johns-hospital-internet-site/ [Accessed on 1 November 2019]Health Service Executive (2019) [Department of Nutrition and Dietetics, Low Residue Diet], unpublished.Health Service Executive (2019) Healthy Eating, available: https://www.hse.ie/eng/health/az/d/diet/ [Accessed 15 November 2019]Health Service Executive (2014) Community Nutrition and Dietetic Service, available: https://www.hse.ie/eng/services/list/2/primarycare/east-coast-diabetes-service/management-of-type-2-diabetes/lifestyle-management/healthy-eating-advice/first-steps-for-food-diabetes.pdf [Accessed 15 November 2019]Fahey, A. (2018) ‘Fundamentals of Nursing Practice’ NM4141 Fundamentals of Nursing Practice, 11th of September 2018, University of Limerick, unpublished. WebMD (2019) WebMD, available: https://www.webmd.com/diabetes/type-2-diabetes-symptoms#1 [Accessed 13 November 2019] O’Brien, B. (2019) ‘Supporting Document for MCQ’ NM4153 Person Centred Surgical Nursing, 4th of November 2018, University of Limerick, unpublished.Drugs.com (2019) Drugs.com, available: https://www.drugs.com/moviprep.html [Accessed 13 November 2019]Mayo Clinic (2019) Mayo Clinic, available: https://www.mayoclinic.org/tests-procedures/colonoscopy/about/pac-20393569 [Accessed 14 November 2019]ASCRS (2019) American Society of Colon and Rectal Surgeons, available: https://www.fascrs.org/patients/disease-condition/diverticular-disease [Accessed 14 November 2019]Brooker, C., Nicol, M. (2011) Alexander’s Nursing Practice, 4th ed., London: Elsevier.BNF (2019) British National Formulary, 78th Revised ed., London: Pharmaceutical Press.American Cancer Society (2019) American Cancer Society, available: https://www.cancer.org/cancer/cancer-causes/diet-physical-activity/body-weight-and-cancer-risk/adult-bmi.html [Accessed 15 November 2019]Safe Food (2019) Safe Food, available: https://www.safefood.eu/Healthy-Eating/The-Food-Pyramid-and-The-Eatwell-Guide.aspx [Accessed 15 November 2019]Butler, N., Newman T. (2017) ‘What is nutrition, and why does it matter?’ , Medical News Today, 1 Sep, available: https://www.medicalnewstoday.com/articles/160774.php [Accessed 15 November 2019]Kingston, L. (2019) ‘Introduction’NM4163 Nutrition in Nursing Practice, 15th of November 2018, University of Limerick, unpublished.