James D. is referred to your outpatient clinic following a recent admit for comp
ID: 126897 • Letter: J
Question
James D. is referred to your outpatient clinic following a recent admit for complications related to his DM type 2. James is a 38 YOWM, 5’9” 210# with a L BKA. He has had multiple admissions to the hospital due to PVD, peripheral neuropathy and dehydration. His most recent admission was for treatment of a non-healing ankle wound that began as a blister and has progressed into a stage 3-pressure ulcer. His foot is cyanotic and the admission was for the purpose of debridement. The physician is quite concerned due to the advanced level of complications in such a young patient. She has referred the patient to your clinic for aggressive outpatient intervention and education.
Lab values:
Albumin: 2.2 mg/dl
Prealbumin 8.9 mg/dl
BUN 52 mg/dl
Creatinine 3.1 mg/dl
Anion gap 12
H/H 10.8/32
Fasting Blood glucose: 210 mg/dl
K+ 4.2 mg/dl
Na + 136
Osmolality 289 mMol/dl
24 hour recall:
2 scrambled eggs
3 slices bacon
2 slices toast with butter
2 tsp jelly
8 ounces orange juice
1 cup whole milk
Large cheeseburger (Mcdonald’s or Burger King)
Large fries
2-3 pkgs ketchup
apple pie
24 ounce coke
4 slices deep dish pepperoni pizza
3-12 ounce beers
6 oreo cookies
Determine a plan of care based on your problem list and assessment. What would be the two most important topics for the patient’s nutritional education? (discuss 2 nutrition education topics for this patient)
Explanation / Answer
Plan of care for Mr. James.D:
Risk for Unstable Blood Glucose: At risk for variation of blood glucose levels from the normal range that may compromise health.
Risk factors
Desired outcomes:
Interventions:
Important topics for nutritional education:
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