Case study
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This is the case study that I presented on a Meals On wheels of Tarrant County Client. I visited the client with one of the managing Dietitians, performed a follow-up call one month later, and then I studied the client's conditions, life situations, and dietary preferences to offer possible interventions to improve the client's quality of life.
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Case study
- 1. Meals On Wheels, Inc. of Tarrant County Case Study For Mr. Davis By Sarah Yanniello
- 2. Client Information • 66 y/o male • Diabetes, COPD, CHF • % weight change: steady weight • All blood values normal
- 3. Medical History/Initial Visit • Medical History: • Diabetes misdiagnosis blood clot CHF Amputations Cardiac Arrest • Initial attitude and self reports
- 4. Pathophysiology • Diabetes • State of Condition • Current treatment and medications • Implications
- 5. Pathophysiology • Chronic Obstructive Pulmonary Disease (COPD) • State of Condition • Current treatment and medications • Implications
- 6. Pathophysiology • Congestive Heart Failure (CHF) • State of Condition • Current treatment and medications • Implications
- 7. Pathophysiology • Amputations • State of Condition • Current treatment and medications • Implications
- 8. Current Treatment • Other conditions • About 17 medications: • Gout • Cholesterol • Pain • *Furosemide Potassium supplement Pantoprozole
- 10. Assessment Cont’d. • Physical appearance • Muscle tone • Appetite
- 11. Assessment Cont’d. • Diet • Knowledge of disease control • Mobility • Medications/ food-drug interactions
- 12. Diagnosis • PES #1: • Occasionaly high BG related to knowledge deficit about diabetes care as evidenced by patient self-reported memory gap. • PES #2: • Occasional high BG related to insufficient diabetes education as evidenced by patient self-reported memory gap.
- 13. Intervention • Meals On Wheels RD will continue diabetes education
- 15. Monitoring/Evaluation • New recommendations/things to check up on • Weight change • Diabetes education recall • Medication list • BG monitoring • Sodium intake eduation
Editor's Notes
- (Controlled) (Gabapentin) Led to blood clot.. Independence: Can bathe/etc. Only needs dressing done and can’t drive Mobility: Needs wheelchair but his arms are okay so he can get around Safety: Social Interaction: Sees daughter and grandchildren regularly.
- (Only minor shortness of breath) (None) doesn’t use oxygen (Hasn’t caused anything else)-> Independence, mobility, safety, or social interaction
- (Currently controlled but risky/needs to be monitored. Medications are very necessary.) Warfarin, amiodarone, aspirin, atorvastatin, Coreg, furosemide(?), nitroglycerin Has led to multiple hospital visits,
- Has led to multiple hospital visits, (Diabetes could be a problem with healing, but it is healing well. He has to use a wheel chair but has been doing PT)
- Diabetes: Gabapentin Ampu: Nurse and daughter to care for wound, PT
- Muscle tone: good, flexible Apetite: Suprisingly good
- FDI: grapefruit,
- Biggest thing is, he eats sweets each day for a snack which is fine, but he says his BG is high sometimes, so I wonder if its b/c he’s not taking insulin with those sweets? I just worry that it could be those occasional drops that may end up causing him problems, and diabetes has caused most of the problems for him, so we need to make sure that it stays controlled.
- Still doing well Good fluid intake Diet hasn’t changed- drinking ensure still, 6 c fluids usually Tried more vegetables from MOW meals Tried the LC and didn't like them Checks BG regularly (and randomly 6-8x/wk) -normal Getting prosthetic leg Does PT every day, sometimes in bed, sometimes wheel chair, “walks outside”
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