I.

Nursing History:

A.

Patients Data:

Patients Initials:

JF

Height: 66 inches

Age: 42

Nationality: African American

Weight: 77.8 lbs (35.4 kg)

BMI: 12.6 (underweight)

Ideal Weight and Range: Ideal weight for an individual of 66 inches would be between
118 to 148 pounds and a BMI of 19 to 24.
Activity Level: Non-Ambulatory, Bedridden
Vital Signs: N/A

B.

Medical Diagnosis: Multiple Sclerosis

C.

Signs and Symptoms:

Contractures: tightening of muscles in upper and lower extremities in the
absence of stimuli
Incontinence: urinary and bowel incontinence; patient wears adult diapers
Hypertension: increased BP; systolic over 140 and/or diastolic over 90
Dysphagia: difficulty swallowing
Extremity Weakness: related to MS; patient is unable to walk due to MS and is
bedridden
Muscle Stiffness: loss of muscle tone due to MS; patient unable to walk and is
bedridden
Stage One Decubitus Ulcer: nonblanchable erytherma of intact skin located on
the sacrum

II.

DIET

A.

Patients Diet:

JF is on a therapeutic diet of high carbohydrates, high protein and low fat. She is also
on a consistency order diet. All foods are pureed and liquids are thickened.
B.

Relationship of diet to disorder:

1.

Normal Nutritional Needs:

According to the Food Pyramid Guide, there are five basic food groups that are
recommended for good nutrition. The guide is based on a 2000 calorie diet and the
amounts needed for each food group are as follows:
GRAINS: 6 ounces every day
VEGETABLES: 2 1/2 cups every day
FRUITS: 2 cups every day
MILK and MILK PRODUCTS: 3 cups every day
MEAT and BEANS: 5 1/2 ounces every day
The recommendation is also to have a healthy balance between food and physical
activity, including at least 30 minutes of physical activity daily. Fats, sugars and salts
should be used sparingly, including butter and margarine.

2.

Reasons for Patients Diet:

Nutritionally balanced meals help the body work to its fullest potential and is particularly
important for people living with long term health conditions like Multiple Sclerosis. A
well-balanced diet can help control weight, decrease fatigue, maintain regular bowel and
bladder function, minimize the risk of skin problems, increase flexibility and improve
muscle strength and range of motion.
Protein is essential for building body tissue in growth, maintenance and repair. It is
particularly important in wound healing. Protein is also a source of energy, providing 4
kcal/g. For JS, high protein is important to help promote healing in regards to her
decubitus ulcers and help minimize additional risks for skin problems. It also serves as
an additional energy source for her fatigue.
The primary function of carbohydrates is to provide energy for cells. Consuming
adequate carbohydrates to meet energy needs has the effect of sparing protein from
being used for energy and is important whenever protein needs are high such as for
wound healing. Carbohydrates deliver 4 kcal/g. High carbohydrates are essential for
energy and help minimize the fatigue associated with MS. If unmanaged, fatigue can
lead to a decrease in appetite and activity.
A consistency order diet, including pureed foods and thickened drinks, is easier to
swallow and requires less chewing. Since JS has difficulty swallowing, thickening
liquids can help prevent potential choking hazards and pureed foods help to minimize
chewing and make swallowing easier.
C.

List foods permitted on prescribed diet.

BEVERAGES: Liquids thickened with honey

MEATS: Pureed meat, poultry or fish
GRAINS: hot cereals, pureed pancakes, pureed pasta, rice cereal
FRUITS: Pureed fruit without seeds or skin, applesauce
VEGETABLES: pureed vegetables without seeds or skin, mashed potatoes, whipped
sweet potatoes
DESSERTS: pudding, yogurt
CONDIMENTS: margarine, honey
D.

List foods not allowed on prescribed diet.

MEATS: whole pieces of meat, seeds, nuts

GRAINS: rice, granola, bread, pizza
FRUITS: raw, whole fruits, raisins
VEGETABLES: raw, whole vegetables, salads
DESSERTS: gelatins or ice cream (become liquid at room temperature), cookies

III.

Menu Planning

BREAKFAST:
Orange Juice thickened with honey - 4 ounces
Water thickened with honey - 4 ounces
Cooked Cereal - 1/2 cup
Pureed pears - 1/2 cup
Pureed bread - 1 slice
Margarine - 1 pat
Jelly - 2 tsp

Milk thickened with honey - 8 ounces

Coffee thickened with honey - 6 ounces
Ensure Pudding
LUNCH
Juice thickened with honey - 8 ounces
Water thickened with honey - 4 ounces
Pureed carrots - 1/2 cup
Pureed chicken - 3 ounces
Mashed potato with smooth gravy - 1 cup
Applesauce - 1/2 cup
Yogurt - 1 cup
Ensure pudding
SNACK
Pureed cottage cheese - 1/2 cup
Pureed peaches - 1/2 cup
DINNER:
Juice thickened with honey - 8 ounces
Water thickened with honey - 4 ounces
Pureed beef with gravy - 3 ounces
Pureed pasta - 1/2 cup
Pureed carrots - 1 cup
Pureed dinner roll - 1 slice
Margarine - 1 pat
Pudding - 4 ounces
Ensure Pudding

FIVE NURSING RESPONSIBILITIES IN REGARDS TO DIET:

Monitor patient for coughing or choking before, during or after swallowing.
Monitor intake of food; monitor patient weight daily
Be aware of location of suction equipment to be used in event of aspiration.
Provide adequate rest periods between meals.
Remove or reduce environmental stimuli (i.e.: conversation, television)
Maintain high-Fowlers position with head flexed slightly forward during meals.
Discuss with and demonstrate the following to patient: upright position during eating,
provision of high-calorie meals, monitoring of patient for weight loss, allowance of time
to eat slowly.
Instruct patient on specific steps to focus concentration while eating: hold food in mouth,
close lips, think about swallowing, swallow food.

IV.

Response to Diet:

Patient was compliant and diet was well tolerated by patient. She ate 85-90% of all
meals. She has progressed from a liquid only diet of Ensure to a puree diet of high
protein, high carbohydrate foods. No signs of choking. Patient exhibited a healthy
appetite when fed on 11/10/10.

VI.

BIBLIOGRAPHY:

Dudek, Susan G. (2006). Nutrition Essentials for Nursing Practice. New York:
Lippincott, Williams & Wilkins.
Gulanick, Meg & Myers, Judith (2007). Nursing Care Plans: Nursing Diagnosis and
Intervention. St. Louis, Missouri: Mosby Elsevier.
My Pyramid: Steps to a Healthier You. (April 2005) Retrieved from
http://www.mypyramid.gov/downloads/MiniPoster.pdf

Schwarz, S. and Leweling, H. (2005) Multiple Sclerosis and nutrition. Multiple

Sclerosis, 11, 24-32.
Swearington, Pamela L. (2008). All-In-One Care Planning Resource. St. Louis,
Missouri: Mosby Elsevier.

Research Paper help

https://www.homeworkping.com/