Assignment 5: Case Study - Diabetes 2
- Due Mar 10 by 11:59pm
- Points 20
- Submitting a text entry box or a file upload
- File Types doc, pdf, docx, and txt
Prompt
Case Study - Diabetes
Objectives:
- Correctly interpret lab values.
- Write a ADIME note.
- Modify a diabetic meal plan based on calculated exchanges while considering patient preferences.
Directions: Interpret the labs. Write a complete ADIME note for B.L., including assessment, PES statement, nutrition prescription (calculate needs - kcals, protein, CHO distribution), interventions, and monitoring/evaluation. Make a suggested dietary modifications to better meet her needs.
CASE PRESENTATION
B.L. is a 58-year-old woman with type 2 diabetes, hypertension, hyperlipidemia, asthma, and obesity. She takes multiple medications, including insulin (Humalog 75/25) but does not have an insulin adjustment algorithm. She struggles with blood glucose control, with recent readings averaging 241 mg/dl. A year ago, her average was 112 mg/dl. She has also had frequent asthma exacerbations, requiring prednisone tapers, which further elevated her blood glucose levels.
B.L. reports financial constraints limiting her access to some prescribed medications. Her diet includes three meals a day with a bedtime snack, and she attempts to count carbohydrates. However, she has been unable to exercise due to asthma and weather conditions.
Physical Exam
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Weight: 302 lb; Height: 5′1″
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Blood Pressure: 130/78 mmHg; Pulse: 88 bpm
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Respirations: 22 per minute
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Lungs: Clear bilaterally
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Lower Extremities: +1 pitting edema bilaterally
Lab Results (please indicate an interpretation for her lab results)
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HbA1c (6 months ago): 7.0% (Target: <7%)
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Creatinine: 0.7 mg/dl (Normal: 0.7–1.4 mg/dl)
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Potassium: 3.4 mg/dl (Normal: 3.5–5.3 mg/dl)
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Total Cholesterol: 211 mg/dl (Target: <200 mg/dl)
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LDL Cholesterol: 128 mg/dl (Target: <100 mg/dl)
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Triglycerides: 154 mg/dl (Target: <150 mg/dl)
ADIME Note Skeleton (Use this as a guide for your note)
Assessment
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Subjective Data: (Patient-reported symptoms, dietary habits, physical activity, medication adherence)
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Objective Data: (Medical history, medications, physical exam findings, lab results)
Diagnosis (PES Statement)
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Problem: (Nutrition-related issue)
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Etiology: (Root cause)
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Signs/Symptoms: (Evidence supporting the diagnosis)
Intervention
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Nutrition Prescription: (Energy, macronutrient needs, meal plan modifications)
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Education/Counseling Goals: (Behavioral changes, meal planning guidance)
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Coordination of Care: (Referrals, collaboration with healthcare team)
Monitoring & Evaluation
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Indicators to Monitor: (Blood glucose trends, weight changes, dietary adherence)
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Follow-up Plan: (Timeframe for reassessment, potential adjustments)
Example 1-Day Diet (Make Improvements to this to meet her calculated needs and CHO distribution)
Breakfast:
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2 large pancakes with syrup and butter
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12 oz orange juice
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2 slices of bacon
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Coffee with 2 tsp sugar and cream
Lunch:
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Cheeseburger on a white bun
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Large fries
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16 oz sweet tea
Dinner:
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Fried chicken (2 pieces)
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Mashed potatoes with gravy
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Cornbread with butter
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12 oz regular soda
Snack:
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Ice cream (1 cup)
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Handful of potato chips
Task: Modify this meal plan to align with diabetes management principles, including appropriate carbohydrate distribution, fiber intake, and balanced macronutrients.
Rubric
Criteria | Ratings | Pts |
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Assessment
Includes all relevant subjective and objective data.
threshold:
pts
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pts
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Diagnosis (PES Statement)
Clearly states a nutrition diagnosis with appropriate problem, etiology, and signs/symptoms.
threshold:
pts
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pts
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Intervention
Provides a well-developed nutrition prescription and counseling plan.
threshold:
pts
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pts
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Monitoring & Evaluation
Identifies clear indicators to monitor and a follow-up plan.
threshold:
pts
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pts
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Meal Plan Modification
Appropriately modifies the given meal plan to align with diabetes management.
threshold:
pts
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pts
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Lab Interpretation
Correctly indicates which labs are High, Low or WNL
threshold:
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pts
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