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Khim Margarette B.

Dionisio
BS Nursing

Case in PointGerald: Recovering following Surgery

Gerald was a 30-year-old African American man who had been a paraplegic for five years. He
lived in a house with his three brothers, who helped take care of him. John did the cooking. He
made fried eggs, grits and bacon, and coffee for breakfast. Pork and potatoes with greens were a
typical dinner. Gerald didnt like milk; it gave him gas.

Gerald loved to play wheelchair basketball with the neighborhood kids. He would have his boom
box blasting on the side of the court and play for hours. The kids loved the attention, and Gerald
loved to be outside. During the school year, Gerald took classes at the local college and tried to
sell his drawings to any admirer. He felt most alive when he was just wheeling around the
neighborhood in the warmer months. Gerald was no good at limiting the amount of time he was
in his chair. He was even worse at staying in bed, off his buttocks. He had a tendency to
develop pressure ulcers. This time Gerald had the worst problem yet. His doctor said he had to
go into the hospital for skin flap surgery to close the decubiti. He would have to stay off his back
at least three weeks, possibly more, until the incision lines had healed. Gerald could not smoke in
the hospital. The doctor was willing to let him use a nicotine patch if needed.

Initially, Gerald did well after surgery. He made the transition to regular food. Within two weeks,
he was complaining of dry, itchy skin, and the doctor was worried about his five-pound weight
loss. The provider ordered a dietary assessment.

ASSESSMENT

1. What do you know about Gerald and his nutrition?

- Gerald has Unbalanced and poor appetite.


2. Did he eat a balanced diet?

- No, he eats unbalanced diet.

3. What barriers were there to his healing?

- Poor nutrition intake; lack of education regarding his condition; uncooperative


4. What foods are a priority for healing?
- Foods with high protein, nutrients high calories

5. How significant is nutrition to this problem?

- With proper nutrition healing will be in a fast phase.


DIAGNOSIS

6. Write at least two diagnoses that apply to Geralds problem.

- Improper balanced diet secondary to depression or loss of appetite


- Malnutrition secondary to improper diet
PLAN/GOAL

7. What is the priority goal for Gerald?

- Proper nutrition in his every meal to improve his weight.


IMPLEMENTATION

8. What does the dietitian need to know about Gerald to help?


- She/He needs to know the wanted foods of Gerald for her to identify what would be the
best plan for Gerald.
9. What is the dietitian likely to recommend?
- High protein, high calories diet

10.How could vitamin supplements help?


- Vitamin supplement can help increase his appetite

11.Who else can help?

- Dietitian, home health care nurse, social worker, own family, significant others.

12.What strategies could be helpful to get Gerald to eat?

- Motivation from family and friends


- Health education by home health care nurse

13.What could a home health nurse do?

- Develop a plan/strategy together with Gerald on how to improve his appetite


and attain a balanced diet

14.What does Gerald need to do to help himself?

- Self motivation

15.If Gerald is unable to eat enough food to maintain his weight, what alternatives does the
doctor have?

- Tube feeding, total parenteral nutrition food supplements; involve the dietitian

EVALUATION/OUTCOME CRITERIA

16.What needs to happen for Gerald to avoid having a feeding tube?

- Attain a proper weight.

17.What criteria will the doctor use to determine if the plan is effective?

- Daily weight
THINKING FURTHER

18.How are Geralds needs similar to those of any other surgical client?

- Same as proper balanced diet

19.What are the most serious consequences if Gerald is unable to heal, even with tube
feedings?

- Severe malnutrition; pressure ulcer unable to heal > dying

RATE THIS PLATE

The dietitian met with Gerald to discuss how to incorporate more protein into his diet. Gerald is
trying to teach his brother John, the cook. What do you think of the meal that Gerald has
planned? Figure how much protein Gerald has planned in his meal.

6 oz sirloin steak

Baked potato with butter and cheddar cheese (1 oz)


1 cup stir-fried mixed vegetables (zucchini, yellow squash, carrots, and green beans)
Hard roll with butter
1 cup custard