Brief History of Case Study:
Presenting Illness: Ms E.H. is an 83 year old female with a chronic history of hypertension and diabetes mellitus came in for routine check-up.
History of Presenting Illness: The 83 year old female patient was in usual state of health with a prolong history of hypertension that was adequately managed on diuretic therapy. She has been given and tried various other medications but for some reasons, her blood pressure is not very well controlled. Since past few days, she has started complaining of polyuria and polyphagia. She has experienced decreased vision for the last couple of months. Apart from that, the patient denies other risk factors pertinent with cigarette smoking, hypercholesterolemia or family history of heart illness.
Her social history suggests that she is a widow and lives alone. She has worked as a nurse but now retired. She does not follow any special diet. She lives in a single bedroom apartment and has a home helper who comes for 3 hours each day. She receives social security and medicare. Psychosocially, she is alert and an active female even though she has arthritic symptoms.
According to the Graf (2013), The Lawton Instrumental Activities of Daily Living (IADL) Scale used for this patient will aid in assessing the nutritional dependency of the individual. In Ms E.H case, her IADL scale scoring is given below:
Ability to use telephone; she operates phone independently while looking up and dialing numbers scoring 1
Shopping; she needs to accompanied for a shopping trip scoring 0
Food preparation; she does not participate in any of the housekeeping tasks scoring 0
Laundry; all laundry has to be done by the helper scoring 0
Mode of transportation; she travels using taxi or personal automobile and can’t travel in public transport and that too with assistance scoring 0
Medicine compliance; she is very responsible and prompt while taking medicines and does not skip doses scoring 1.
Ability to handle finances; she can adequately manage day-to-day budgeting but needs help with banking and major buying scoring 1.
According to U.S National Library of Medicine (2015), a diet constituting of all the macro and micro molecules in adequate quantities have shown to reduce the risk of various geriatric ailments like osteoporosis, hypertension, certain cancers and hypercholesterolemia. In order to achieve dietary goals, senior population is advised to get variety of healthy foods, avoidance of empty calories and consumption of low fat foods. Similarly, in this case Ms E.H. needs dependency on other people to properly cook and prepare food. She has a long standing hypertension and early symptomatology of diabetes. Therefore, dietary alterations can play a very pivotal role in keeping the disease in primitive stages and achieving optimal levels. For hypertension, reduced salt intake and DASH diet should be started and for diabetes, she should take low carbohydrate and low fat diet (Mayo Clinic, 2013).
Ms E.H has early symptoms that are strongly suggesting towards development of diabetes which poses a great risk on her to develop a coronary artery disorder. This, in turns, increases morbidity and mortality. Low sodium intake will keep her plasma volume low leading to controlled blood pressures. Higher or uncontrolled blood pressures have shown greater preponderance to develop ischemic or hemorrhagic stroke which significantly alters quality of life.
Graf, C. (2013). The Lawton Instrumental Activities of Daily Living Scale. AJN, American Journal Of Nursing, 108(4), 52-62. doi:10.1097/01.naj.0000314810.46029.74
Mayoclinic.org,. (2013). DASH diet: Healthy eating to lower your blood pressure - Mayo Clinic. Retrieved 13 July 2015, from http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/dash-diet/art-20048456
U.S National Library of Medicine,. (2015). Nutrition for Seniors: MedlinePlus. Retrieved 13 July 2015, from http://www.nlm.nih.gov/medlineplus/nutritionforseniors.html