Order Instructions:
Mrs. Folley is a 51-year-old African American female who works as a bookkeeper for an insurance company. Her father and brother have type 2 diabetes mellitus, and have had severe complications because of poor control of blood glucose.
She is 5’ 4” tall and weighs 174 pounds with a medium frame. She has a history of obesity, hypertension, hypothyroidism, and frequent urinary tract infections, and is currently taking propranolol and levothyroxine.
Mrs. Folley complains of constant fatigue over the past two months and has lost 8 pounds, although she is thirsty and hungry and eats all the time. She is concerned that she may have another urinary tract infection because she has frequent urination and pain in her lower abdomen. Her physician orders some fasting blood tests and the results show the following: glucose 380 mg/dL (normal 70-110 mg/dL), HbA1c 7.6% (normal < 6%), serum LDL cholesterol 270 mg/dL (normal <200 mg/dL), triglycerides 290 mg/dL (normal <200 mg/dL). She is diagnosed with type 2 diabetes, and started on a 1200-kcal diet and glyburide. She is also scheduled to see the nurse, who is a Certified Diabetes Educator (CDE), at the end of the week for further counseling.
A. What are the seven (7) symptoms of type 2 diabetes that Mrs. Folley manifests? 1.5 POINTS
a.
b.
c.
d.
e.
f.
g.
Explain the four (4) pathophysiology symptoms of this disease. 1.5 POINTS
a.
b.
c.
d.
What are three (3) points that explain the relationship between being overweight or obese and diabetes? 1.5 POINTS
a.
b.
c.
A. What are two (2) statements that explain what is HbA1c? 2.0 POINTS
a.
b.
What are three (3) ways that HbA1c is used to monitor diabetes? 2.0 POINTS
a.
b.
c.
In view of her other laboratory results, what other six (6) dietary counseling will Mrs. Folley need? 2.0 POINTS
a.
b.
c.
d.
e.
f.
A. What is the difference between the two meal planning strategies, exchange lists and carbohydrate counting? 3.0 POINTS
a.
b.
Which strategy do you think the CDE will teach Mrs. Folley? Why? 3.0 POINTS
a.
b.
Mrs. Folley’s family members suffer from some of the complications of uncontrolled diabetes. What are the seven (7) chronic complications that she is at risk for developing? 3.0 POINTS
a.
b.
c.
d.
e.
f.
g.
What are three (3) reason why is a referral to a Certified Diabetes Educator important for this patient? 2.0 POINTS
a.
b.
c.
Chapter 21: Worksheet 21-2: Case Study – Hypertension
25 of 25 points
Lenora is a 57-year-old Caucasian female who works in a hospital as a desk clerk. She lives alone in a two-bedroom apartment and says that she is often “tight for money.” She is in the process of going through a divorce and is dealing with the emotional and economic problems of the process. She has three children: a son and daughter who are married, and another daughter who attends college across the country. Both of her parents are deceased.
Lenora has been diagnosed with hypertension and clinical depression. She says that hypertension “runs in the family,” and that two siblings have hypertension. Lenora is taking atenolol (Tenormin) and hydrochlorothiazide (Hydrodiuril) for hypertension. For her depression she was prescribed imipramine (Tofranil) and citalopram (Celexa).
She is 5’ 5” tall and weighs 181 pounds with a large frame size and a BMI of 30.1 (obese). Prior to treatment her blood pressure was 150/105, but currently is controlled. At her most recent check-up, her blood pressure was 112/84.
Lenora states that because she lives alone, she infrequently shops or cooks for herself. For breakfast she drinks a cup of coffee with a granola bar or a bag of microwave popcorn. For lunch she usually eats a large garden salad with shredded Swiss cheese, olives, and about 6 oz of ranch dressing. She eats dinner out at least 3 times a week with friends and usually selects pizza, pasta, chicken, and seafood. For snacks, she enjoys chocolate candy, popcorn, and colas. When eating out she usually has alcohol, typically drinking a couple of glasses (16 oz.) of Amaretto Sours. Lenora states that when she selects foods to eat, she does not consider their nutritional value. She sees eating and drinking socially with her friends as one of her primary means of relieving stress or tension.
When Lenora gets home from work, she is often too tired to go the gym, even though it is readily accessible in her apartment complex. She walks with a friend twice a week for about 30 minutes. However, she said that this activity is more for social contact than for exercise. She states that she feels guilty about not going to the gym, but it has not caused her to change her behavior.
What are four (4) complications of uncontrolled hypertension? 4.0 POINTS
a.
b.
c.
d.
What are the five (5) risk factors that Lenora has that are associated with the development of hypertension? 5.0 POINTS
a.
b.
c.
d.
e.
Aside from dietary changes, what are three (3) other lifestyle changes that Lenora can make that may improve her blood pressure? 3.0 POINTS
a.
b.
c.
What are five (5) general dietary recommendations would be helpful to Lenora? 2.5 POINTS
a.
b.
c.
d.
e.
What seven (7) recommendations might you make to Lenora about weight reduction and exercise? 3.5 POINTS
a.
b.
c.
d.
e.
f.
g.
What six (6) potential diet-drug interactions and recommendations are important to share with Lenora? 3.0 POINTS
a.
b.
c.
d.
e.
f.
What are four (4) things that Lenora’s depression might affect her nutritional status? 4.0 POINTS
a.
b.
c.
d.
_________________________
________________________