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Care Presentation

Melina Conrad
Patient AA

● 38 y/o male
● 5’ 6”, 93.6kg
● Film Maker
● From the Philippines
● Married, 1 child
● Large family
○ Mom and dad have 13
siblings each
Admit Diagnosis/PMH/Course of
Hospitalization

● Liver abscess, bacterial infection


● Presented with fever, fatigue, chills, poor appetite
● Taking metformin twice daily
● PMH Type 2 Diabetes (only diagnosed 1 year ago), hypertension

Walk in Clinic ER Backus Hospital


What is a liver abscess?

● Bacterial infection causes the abscess


● Symptoms include
○ Fever, sweats, chills, fatigue etc.

Had this procedure done and


was draining into a bag
Medications

Drug/Generic Name Purpose Side Effect Nutritional Concerns

Lantus Manage blood Weight gain, itching Consistent carb


sugars intake

Humalog Manage blood Weight gain, itching Consistent carb


sugars intake

Glimepiriade (1mg Manage blood Weight gain, itching Consistent carb


w/ breakfast sugars intake
Labs
HgA1C 10/11 9.2%
AM PM

Glucose 10/10 (day after 358 309


admit)

Glucose 10/11 265 316

Glucose 10/15 (day I saw 190 199


him)
Nutritional Assessment

● Busy worker, 6 days a week 10-16 hr days


● Put on 30lbs since marriage and kids
● Previously was active (snowboarding, hiking etc.)
● Diagnosed with T2DM 1 year ago
● Never had met with a dietitian :(
● Low nutrition/diagnosis knowledge level
PES

Food and nutrition related knowledge deficit RT


T2DM AEB HgA1C of 9.2% and pt stating limited
knowledge about diabetes diagnosis and
consistent carb intake
Intervention

● Education, Education, Education!!


● Educated about
○ What is a consistent carb diet?
○ What is a serving of carbs?
○ How to read a nutrition label and focus on carbs
○ Food groups and their servings of carbs
Monitoring/Evaluation

● Continue consistent carb diet (60g per meal and 3 snacks at 15g)
● Moderate weight loss of 1 lb a week until back at pre marriage weight of 175
lbs
● HgA1c ≤7% by next reading in 3 months
● Pt able to state three foods that are 1 serving of carbs (15g)
Research Article

● Shows need for


team effort
● Better outcomes
● Better adherence
Citations
Grohmann, B et. al. Patients’ experiences of diabetes education teams integrated into primary care Canadian Family
Physician Feb 2017, 63 (2) e128-e136; DOA 10/23/18.
Krause’s Food & the Nutrition Care Process, 14th ed., Mahan & Escott-Stump, 2016
Food Medication Interaction 18th ed., Pronsky et. al. 2015
Medical Terminology: a Short Course 7th Edition: 7th, Davi-Ellen Chabner, 2014.