Care Presentation

Care Presentation Melina Conrad

Patient AA ● ● ● ● ● ●

38 y/o male 5’ 6”, 93.6kg Film Maker From the Philippines Married, 1 child Large family ○

Mom and dad have 13 siblings each

Admit Diagnosis/PMH/Course of Hospitalization ● ● ● ●

Liver abscess, bacterial infection Presented with fever, fatigue, chills, poor appetite Taking metformin twice daily PMH Type 2 Diabetes (only diagnosed 1 year ago), hypertension

Walk in Clinic

ER

Backus Hospital

What is a liver abscess? ● ●

Bacterial infection causes the abscess Symptoms include ○

Fever, sweats, chills, fatigue etc.

Had this procedure done and was draining into a bag

Medications Drug/Generic Name

Purpose

Side Effect

Nutritional Concerns

Lantus

Manage blood sugars

Weight gain, itching

Consistent carb intake

Humalog

Manage blood sugars

Weight gain, itching

Consistent carb intake

Glimepiriade (1mg w/ breakfast

Manage blood sugars

Weight gain, itching

Consistent carb intake

Labs

HgA1C 10/11 9.2% AM

PM

Glucose 10/10 (day after admit)

358

309

Glucose 10/11

265

316

Glucose 10/15 (day I saw him)

190

199

Nutritional Assessment ● ● ● ● ● ●

Busy worker, 6 days a week 10-16 hr days Put on 30lbs since marriage and kids Previously was active (snowboarding, hiking etc.) Diagnosed with T2DM 1 year ago Never had met with a dietitian :( Low nutrition/diagnosis knowledge level

PES Food and nutrition related knowledge deficit RT T2DM AEB HgA1C of 9.2% and pt stating limited knowledge about diabetes diagnosis and consistent carb intake

Intervention ● Education, Education, Education!! ●

Educated about ○ ○ ○ ○

What is a consistent carb diet? What is a serving of carbs? How to read a nutrition label and focus on carbs Food groups and their servings of carbs

Monitoring/Evaluation ● ● ● ●

Continue consistent carb diet (60g per meal and 3 snacks at 15g) Moderate weight loss of 1 lb a week until back at pre marriage weight of 175 lbs HgA1c ≤7% by next reading in 3 months Pt able to state three foods that are 1 serving of carbs (15g)

Research Article ● ● ●

Shows need for team effort Better outcomes Better adherence

Citations Grohmann, B et. al. Patients’ experiences of diabetes education teams integrated into primary care Canadian Family Physician Feb 2017, 63 (2) e128-e136; DOA 10/23/18. Krause’s Food & the Nutrition Care Process, 14th ed., Mahan & Escott-Stump, 2016 Food Medication Interaction 18th ed., Pronsky et. al. 2015 Medical Terminology: a Short Course 7th Edition: 7th, Davi-Ellen Chabner, 2014.