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1. Mr. DeVita is a 42-year-old male who has been in an accident in which he received severe burns. As a result, he is in severe metabolic stress. Mr. DeVita weighed 186 pounds before the accident. Calculate his protein requirements. Based on the information you have, what are Mr. DeVita’s fluid requirements? What are some additional nutritional concerns that you as his nurse, would have with a burn patient? Is nutrition even a real consideration at this point in his care? Why or why not?

2. Katie Burch, a patient with type 1diabetes, reports that she has been experiencing symptoms of hypoglycemia. She wears an insulin pump. However, when she monitors her glucose levels, they are within normal limits. How can you help her understand what could be happening metabolically and physiologically? On further assessment, you find that Katie also has difficulties with dietary compliance. Using your assessment skills, try to identify the obstacles and ways to assist in finding solutions to the problem.

3. Alan is a 58-year-old patient who has the following risk factors for cardiovascular disease: primary hypertension (treated with medication), cigarette smoking, inactive lifestyle, and occasionally eating foods high in sodium. Both of his parents died at young ages due to what Alan calls “heart troubles,” and his brother has high cholesterol. As his nurse, you know that risk factors for cardiovascular disease are fixed or modifiable. Give at least two examples of each. What is considered high risk for each variable? For modifiable risk factors, what can be done to reduce risk? How would you counsel Alan?

4. Jordan is a 14 year old middle school student, weighing 275 pounds and is 5’6” tall. Over the past 2 years, he has gained 60 pounds, as he has begun to withdraw from social activities, and avoid other students, due to bullying from others his age about his weight/appearance. Lately, Jordan has been missing a great deal of school too, particularly on the days he has gym. Jordan’s parents are both average in height and weight, and Jordan’s mother says that he just takes after his grandfather William, who “was a husky man, and died of a sudden heart attack at the age of 44”. She says “We just have fat genes in the family; you can’t do anything about that”!
He has been told he had “no willpower, or is weak, or that he needed to change his lifestyle, eat less and exercise more.” Jordan says “I go for a couple days without eating, but then I get so hungry that I could eat the couch”! You are the school nurse doing height and weight assessments on the middle school group this year. How would you assess and advise Jordan?

5. Michelle, 50 years old, is recovering from breast cancer surgery. She has been experiencing side effects from chemotherapy, particularly nausea and vomiting. Subsequently she has been losing weight, but currently her weight is stable. During the assessment, she mentions that she has been seeing a naturopathic physician to reduce the symptoms related to chemotherapy. Part of this plan includes restricting some fruits and vegetables, fat, and kcal. What, as the patient’s nurse, are your concerns regarding these recommendations? What are the dietary requirements that Michelle should have as she undergoes her chemotherapy?

1. Elderly Case Study
You are asked to see Mr. Basset, who is 80 years old and has recently lost his wife. His children do not live nearby, but Mr. Basset sees them on holidays. Mr. Basset has had an unexplained weight loss of 20 pounds in 3 months. He is taking medication for hypertension and arthritis.
Mr. Basset reports that his wife did most of the cooking and he has limited cooking skills. He usually has cereal with milk and coffee for breakfast and soup for a second meal later in the day. He eats crackers throughout the day if he is hungry. In addition, Mr. Basset has ill-fitting dentures and claims that food just does not taste the same. He is also on a limited budget. More than anything, however, Mr. Basset is lonely.
Discussion Questions
a. What physiological factors might contribute to Mr. Basset’s weight loss?
b. What psychosocial factors might contribute to Mr. Basset’s weight loss?
c. Give one likely explanation why Mr. Basset’s dentures do not fit.
d. What community resources might be used to improve Mr. Basset’s nutritional status?
e. Compare the risk factors described in Mr. Basset’s case with the “Determine Your Nutritional Health” checklist from the Nutrition Screening Initiative (Teaching Tool box in Chapter 13 of the text).

2. Young Adult Case Study
Kylie is a 22-year-old female who is in her senior year of college. She tearfully discloses in confidence to you, a nursing student and her best friend, that she has had some concerns about her weight for much of her adolescent and young adult life. She has just gotten engaged to Michael, they are excitedly planning their wedding, and Michael says he “Can’t wait to have children!”

Because she had dreams of becoming a professional ballet dancer, Kylie has always had to restrict her weight from a young age. She believes her training in dancing contributed to the intense preoccupation she has with her weight and body image. She recalls being repeatedly told that she was too fat by her dance instructors, despite the fact that she dieted constantly, and friends have always told her that she looked quite thin. Kylie has not been able to shake the feeling that she is too fat at her current weight of 98 pounds (Kylie is 5 feet, 10 inches tall). Kylie says that she sometimes gets so hungry after dieting for several days that she will simply lose control of her eating and consume large amounts of junk food.
Feeling horrible about having broken her diet, she would then force herself to throw up what she had eaten. This cycle would repeat itself weekly, and has been going on for about 5 years. Kylie has become concerned because her menstrual cycles have not yet started, and she is becoming concerned about her ability to have children and what Michael would think if he knew about her preoccupation with her weight.

Discussion Questions
a. As Kylie’s best friend, what steps might you take in discussing this problem with her, or wouldn’t you? Why or why not?
b. What are some factors that contribute to the development of eating disorders?
c. What are some of the health risks associated with eating disorders?
d. Should you tell Michael, Kylie’s fiancé, about this conversation? Why or why not?
e. What are some treatment options for Kylie’s eating disorder?

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