MK OLeary

NUTR334
Nutrition Initial Assessment:
Admitting Diagnosis: Uncontrolled Adult Type 2 DM and HHS
Age: 53

Gender: male

Reason for Assessment:

Consulted for diet advancement, total carbohydrate Rx, and distribution as
well as education for self- management training for patient.
Patient History
HPI:
Patient is 53 yo male presents alert but previously with drowsiness and mild
confusion. Serum glucose when admitted was 855 mg/dL. Patient stated that
he had been vomiting for approximately 12-24 hours prior and has nothing to
eat other than sips of water. He admits to not taking diabetes medications
regularly because he does not like the way they make him feel, but almost
always takes his blood pressure and cholesterol medications.
Past Medical/ Surgical History:
Type 2 DM x 1 year and prescribed glyburide and metformin twice daily but
admits that he has not taken the medication regularly; HTN; hyperlipidemia,
gout. Open reduction and internal fixation surgery to right ulna and hernia
repair. Smoked 1 ppd for 20 years but has now quit. Drinks 3-4 alcoholic
drinks per week. Family history includes HTN, CAD (father). And type 2 DM
(mother).

Patient Interview:
Patient presents alert but previously drowsy with mild confusion after
vomiting for 12-24 hours. He admits that he has not taken diabetes
medications regularly as he hates how they make him feel. He also says that
he does not follow any strict diet, except for not adding salt, trying to avoid
high cholesterol food, and staying away from high sugar desserts. He has
never seen anyone for diabetes teaching beyond what his physician told him.
Diet History:
Not following any specific diet, except for not adding salt, trying to avoid
high cholesterol food, and staying away from high sugar desserts. Patient
does not take diabetes medication as prescribed and has uncontrolled Type 2
DM.
Significant Meds:
Glyburide 20 mg daily (taken irregularly); 500 mg metformin twice daily
(taken irregularly); dyazide once daily; lipitor 20 mg daily (home); IVF to D5
45 NS with 20MEq K @ 135 mL/hr/ Lispro 0.5 u every 2 hours until glucose is
150-200mg/dL- progress using ICR 1:15; Glargine 19 u.

Labs: (include both dates if needed)

9.8
135

100

20

475

2.1

4.0

28

1.3

2.1

Diet Prior to Admission: Regular (with no added salt to meals)

Current Diet Order: Consistent Carbohydrate Controlled Diet- Long Term
(following step up progression from NPOx12 hrs, then clear liquid diet)
Nutrition-Focused Physical Findings
Physical Appearance:
Appears pale, skin diaphoretic and warm with poor turgor, dry mucous
membranes without exudates or lesions. Normal heart rhythms & rate; eyes:
PERRLA; ears & nose clear; chest/lung respirations are rapid. Urine- cloudy
and amber.
Anthropometrics
Height: Admit Weight:
59

97.3 kg

Current
Weight:

BMI:
31.6

97.3 kg
IBW:
72.7

%IBW:

UBW:

% UBW:

133.8%

97.3 kg

100%

kg

Weight Hx: unknown

Weight Comment: BMI classifies patient as obese

Intake and Digestive problems: Significant nausea & vomiting prior to

admission
Estimated Nutrient Needs: (based on ABW of 78.9)
Calories: 1663-1995 cal/day (based on HBE coefficient of 1.0-1.2 based
on patient being mainly on bed rest)
Protein: 0.8-1.0 g/kg = 63-79 g/day
Fluid: 2000-2500 ml/day (Based on MD order, as patient is dehydrated
& HHS)
Estimate of current/previous intake: Excessive (based on obesity
classification and diet recall)
Nutrition Risk: High disease risk (not at risk for malnutrition)
Summary: 53 yo male admitted with acute hyperglycemia and was
diagnosed with uncontrolled Type 2 DM with HHS. Patient presented alert but
with prior confusion and drowsiness after vomiting for approximately 12-24
hours. States that he does not take diabetes medication regularly or follow
any specific diet other than not adding salt to meals, trying to avoid high
cholesterol food, and staying away from high sugar desserts. Patient was
NPO and advanced to clear liquid diet after being treated with regular insulin.
Nutrition Diagnostic Statements
1. Excessive energy intake related to frequent intake of high caloric
foods/restaurant food as evidenced by BMI of 31.6 and diet recall.

2. Inconsistent carbohydrate intake related to lack of knowledge of

carbohydrate counting as evidenced by diet recall, patient interview,
HBA1C, and elevated glucose lab value of 855 mg/dL.
Nutrition Intervention
1. Nutrition Education
Educate patient on the importance of taking diabetes medications

correctly
Educate patient on healthier food choices & moderate physical activity
Educate patient on consistent carbohydrate counseling:
o Based on caloric needs of 1663-1995, he needs 832-998 calories
from carbohydrates per day, which means he needs 208-250
grams of carbohydrates each day. This means that he can have
14-17 servings (15g of carbohydrates each) a day. Ideally, we
would want him to be consistent, breaking up his carbohydrates
per meal, having 4-5 servings for breakfast, lunch, and dinner

and 1-2 servings for his evening snack.

2. Coordination of care
Refer to outpatient RD for weight loss and diabetes self management

education monthly.
Suggest that patient keep a food log with carbohydrate counts for RD
to monitor

Nutrition Monitoring and Evaluation

Anthropometrics:
1. Monitor weight and BMI monthly
Biochemical Data & Procedures:

2. Monitor lab values monthly: blood glucose & HBA1C

Food & Nutrition related History:
3. Continue education monthly with outpatient RD to go over
progress/issues and carb counting log
MK OLeary, Nutr 334 student, 3/30/16