Disease and Nutrition Gloria Lyles West Coast University, Ontario

My patient is J.W., he is a 60-year-old African-American male who identifies as Catholic. J.W. is 6’0” in height and weighs 230lbs. The patient is married and has three children. He leads a fairly sedentary lifestyle as he travels three days a week for work and tends to eat out three meals per day. His current diet consists of high-calorie fast food which is low in nutrients. The patient has been diagnosed with hypertension (HTN), and diabetes Mellitus type (DM2), and his doctor has recommended that he lose one pound per week for three months to help him achieve a healthy weight.

Medications that J.W. is currently taking are Metformin 500mg twice a day, Metropolol 200mg once daily as well as a multivitamin. J.W.’s body mass index is at 31.2 which categorizes him as obese. For a male of his height, the BMI chart recommends that he should weigh between 140lbs-180lbs to be considered healthy (aim for healthy weight 2018).

J.W. stated that he eats fast food three times a day, and although some healthy choices can be made when eating out, most people opt for the less healthy options. Based on what Americans commonly eat in fast-food restaurants, such as burgers and fries with say, a coke, J.W.’s diet is high in fat, cholesterol, sodium, and sugar. There is some protein in there, however, fat, cholesterol, and sodium far outweigh the amount of protein. For J.W. to achieve the one-pound weight loss per week, he will have to learn what the healthier options are at the places he eats and stick to those when eating on the go. Restaurants such as Subway offer healthier options. They serve egg white omelets for breakfast and lean meats or veggie subs for lunch. Mcdonald’s and Starbucks offer oatmeal for breakfast, chicken wraps, and chicken salads as their healthier options. One of the most popular now, Chick-Fil-A offers a variety of salads as well as skinless grilled nuggets and chicken strips. Panera also has some sensible meals, soup or salad and a sandwich for lunch for example (fast food places that serve healthy foods). Most people in our society today are always on the go and it is less likely that we eat homecooked meals every day, which is why we must educate patients on proper nutrition even when having to eat out often.

Micronutrients are defined as “nutrients that are needed in small amounts” (Dudek, 2018), these are our vitamins and minerals. Vitamins A, D, E, and K are fat-soluble vitamins. Since these are not easily excreted through urine and so it is important to take only what is needed to avoid toxicity (Dudek 2018). Vitamin A aids with eyesight, bone development, teeth development, and immune function, and promotes healthy skin and hair (Dudek, 2018). Due to the foods that J.W. eats such as the beef in cheeseburgers, it is unlikely that he would develop a deficiency in vitamin A. There are however healthier options such as fruits and vegetables by which he can obtain the needed amount of vitamin A. Carrots and sweet potatoes are known to be great sources of vitamin A. Vitamin D is extremely important in bone development. Vitamin D comes from sunlight, oil, milk, fish, egg yolks, and liver (Dudek 2018). A deficiency in vitamin D could cause hormonal imbalances, affect bone growth and density, decay teeth, and negatively affect absorption in the GI tract (Dudek 2018). If vitamin D levels drop low enough, the patient could experience muscle twitches, tingling around the mouth, and tingling in the distal extremities (Dudek 2018). Since J.W. travels for work, I suspect he does not spend much time in the sunlight. Also, because J.W. is African American, he would need to be in the sunlight for a prolonged amount of time in order fully benefit. J.W. is likely deficient in vitamin D or at the very least he has a low level of vitamin D. A deficiency in vitamin E, although rare, can cause a patient to be anemic, swollen, or produce skin lesions (Dudek 2018). Foods that provide vitamin E are vegetable oils, leafy green vegetables, whole grains, and nuts (Harvard Health Publishing). With the description of J.W.’s diet, I would suspect that his vitamin E is on the lower end. Finally, vitamin K aids in clotting the blood. Some foods that provide vitamin K are cabbage, eggs, milk, spinach, broccoli, and kale (Harvard Health Publishing), again, I would suspect that J.W. is also deficient in vitamin K or at least has low levels of vitamin K. Because J.W. does have hypertension, he also needs to monitor his sodium level intake. The recommended daily intake of sodium is 2300mg. This number should be greatly reduced due to J.W.’s age and condition. J.W. should consume no more than 1500mg of sodium per day (Shaking the salt habit to lower blood pressure, 2019).

J.W. has been diagnosed with two major conditions, type 2 diabetes, and hypertension. Hypertension has both modifiable factors and nonmodifiable factors (Nutrition ATI). Some modifications that J.W. could make to help with his hypertension are to lower sodium consumption, incorporate physical activity at least 30 minutes a day, even if it is just a brisk walk, lose weight, smoking cessation, and add more fruits and vegetables to his diet (Nutrition ATI). Type two diabetes also has some modifiable risk factors such as exercising and maintaining a healthy weight. According to the American Heart Association, adults with diabetes are more likely to die from heart disease than adults without diabetes. Cardiovascular disease is the number one killer of diabetics (Dudek 2018). Since J.W. leads a very sedentary lifestyle, even light exercise will make a huge difference in his health. As he loses weight and gains endurance, he can aim for higher-intensity workouts.

J.W. currently takes Metformin, Metropolol, and a multivitamin. Metformin is used in controlling blood sugar in type 2 diabetes. J.W. should be educated on the effects of Metformin and should monitor his blood glucose levels regularly while on this medication. He should also know the signs and symptoms of hypoglycemia such as pallor, tremors, diaphoresis, palpitations, and anxiety as hypoglycemia could be fatal if not treated effectively (Copstead and Banasik 2013). Metoprolol is a Beta-adrenergic blocker used to regulate blood pressure. When taking this medication J.W. should monitor himself for hypotension as it is one of the side effects. According to Copstead and Banasik, this medication could also cause anxiety and heart palpitations. It is important that J.W. talk to his provider about all medications, prescribed and over the counter, to prevent any contraindications or severe interactions.

According to Dudek, a diabetic patient should consume 1500-2000 calories per day. For J.W. to lose one pound per week, his daily consumption should be as follows:

• Calories (1500-2000)
• Carbohydrates (231g/day)
• Fat (62g/day)
• Protein (93g/day)
• Cholesterol (Sodium (Sugar (69g)
• Fiber (30-35g)

I have personally experienced how difficult it is to control diabetes, as I got a brief taste of it during pregnancy. I have found that when patients are told to cut a particular food out of their diet, they become overwhelmed. J.W. should slowly start to moderate his diet for him to be able to make a sustainable change. He should also not deprive himself of “bad” foods, but rather understand that those foods should be consumed less often, for example, maybe have a burger on the weekend as a treat for having eaten healthier options throughout the week. J.W. should also carry healthy snacks with him to avoid purchasing something unhealthy throughout the day.

If J.W. can make small modifications to his diet and physical activity he should have no problem losing the recommended one pound per week. The most difficult part of any new diet or exercise routine is getting started, after that, consistency is key and it is easier to be consistent once the patient notices positive changes in their health and their physical appearance. At the end of the day, the goal is to allow J.W. to continue to enjoy his family to the fullest for a long time to come, and I think he will be able to achieve this goal.

Reference:

1. Aim for a Healthy Weight: Calculate your Body Mass Index (n.d.). In National Heart, Lung, and Blood Institute. Retrieved November 18, 2018, from https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
2. ATI Nutrition for Nursing (6.0th ed., pp. 87-89). (2016). N.p.: Assessment Technologies Institute.
3. Cardiovascular Disease and Diabetes (2015, August). In American Heart Association. Retrieved from https://www.heart.org/en/health-topics/diabetes/why-diabetes-matters/cardiovascular-disease–diabetes
4. Copstead, Lee-Ellen and Banasik, Jacquelyn (2013). Pathophysiology 5th edition. St. Louis MI, Elsevier.
5. Dudek, S.G. (2018) Nutrition Essentials for Nursing Practice 8th edition. Philadelphia, PA Wolters Kluwers.
6. Hernandez, Amanda. (n.d.). Fast Food Places That Serve Healthy Foods. Healthy Eating | SF Gate. Retrieved from http://healthyeating.sfgate.com/fast-food-places-serve-healthy-foods-9739.html
7. Shaking the Salt Habit to Lower High Blood Pressure (2016, October). In American Heart Association. Retrieved from https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/shaking-the-salt-habit-to-lower-high-blood-pressure
8. The Best Foods for Vitamins and Minerals (2016, September). In Harvard Health Publishing Harvard Medical School. Retrieved from https://www.health.harvard.edu/staying-healthy/the-best-foods-for-vitamins-and-minerals

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