Krause\'s Food & the Nutrition Care Process CLINICAL SCENARIO Chapter 8 case stu
ID: 82302 • Letter: K
Question
Krause's Food & the Nutrition Care Process CLINICAL SCENARIO Chapter 8 case study
Charles is a 29-year-old man who began to suffer seizures after a head trauma injury from a motorcycle accident at the age of 18. For the first 2 years after the accident, he was prescribed various anticonvulsant regi- mens. The combination of phenytoin (Dilantin), 300 mg daily, and pheno- barbital, 120 mg daily, has proven to be the most effective therapy to control his seizures. Charles has been stabilized on this regimen for the last 11 years.
Charles is a senior computer programmer for a large corporation. He is 6 feet 2 inches tall and weighs 187 lb. He admits to having an aversion for exercise and athletics. In his free time, he enjoys reading, playing com- puter games, and watching television. During the past year, Charles has broken his left femur and tibia on two separate occasions. He broke his femur when he missed the bottom step on the stairway in his office build- ing. Several months later he broke his tibia when he tripped over a broken branch in his yard. Charles recently complained to his orthopedic surgeon about hip and pelvic pain of several weeks’ duration. An orthopedic ex- amination with x-ray examination, bone scan, and DXA scan revealed that Charles is suffering from osteomalacia. A review of Charles
typical diet reveals a nutritionally marginal diet that commonly includes fast foods and frozen dinners. His diet is generally deficient in fresh fruits, vegetables, and dairy products.
Nutrition Diagnostic Statement:
Food-medication interaction related to inadequate calcium and vitamin D in- take while taking anticonvulsant medications as evidenced by osteomalacia.
1. What is Charles’s BMI? And category?
2. What influences the half-life of the medications Charles is taking?
3. Charles takes phenytoin (Dilantin) which is a drug that alters the absorption of the nutrient_______________ and can affect taste (dysgeusia).
4. What are good food sources of this nutrient (answer #3) that you will recommend Charles include in his diet?
5. Phenobarbitol is a CNS- depressant medication, what should Charles avoid because the combination could induce excessive drowsiness and even death?
6. Charles is at risk for drug-nutrient interactions because he has been taking this medication for 11 years, other persons considered at higher risk for drug-nutrient interactions include:
7. What vitamin and mineral deficiencies may have contributed to the current state of Charles’ bones ?
8. How will you explain osteomalacia to Charles? (Chapter 24)?
9. What foods would you recommend that Charles add to his diet to get these?
10. What lifestyle change will influence his bone health?
Explanation / Answer
1) Charles BMI is 24 from
BMI = x KG / (y M * y M)
Where:
x=bodyweight in KG
y=height in m
And it falls under normal category.
2) Factors that influence the Half life of the anticonvulsant drugs are
3) it alters the absorption of FOLIC ACID that can effect the taste.
4) Asparagus, avocado, broccoli, leafy vegetables, citrus fruits and beans can Charles add in his diet that will be able to stabilize his Folic acid needs.
5) Charles should avoid ALCOHOL with Phenobarbitol because the combination of both leads to acute alcohol intoxication that leads to dizziness, drowsiness and even death.
6) Question 6 is incomplete.
7)vitamin D, phosphate and calcium deficiency can lead to osteomalacia.
8) In the layman language the osteomalacia is softening of bones because if impaired metabolism.
9) For vitamin D Charles should include oily fish (salmon, mackerel, sardines) and egg yolks. Also look for foods fortified with vitamin D, such as cereal, bread, milk and yogurt. These are also rich in phosphate and calcium.
10) For betterment of his bones Charles should start weigh-bearimg exercises. He should avoid alcohol and quit smoking. He should also improve his diet by taking the food with vitamin D.
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