Question

Kathy Morningside is a 55-year-old woman who has had spells of gastroin- testinal problems over the years (dyspepsia), but a formal diagnosis has never been conclusive. During the past four months, she has had a history of vomiting after some meals and she has lost about 5 kg over this time. Mrs Morningside, together with an old school chum, went to London for a weekend theatre break to see Les Miserables. On the Friday evening, she began to feel unwell, but put it down to her fear of flying. They went to the theatre on the Saturday evening and followed this with a light opera supper at a nearby restaurant. Mrs Morningside suffered a haematemesis and was rushed to hospital with massive bleeding. Her condition settled and follow- ing overnight rehydration, she returned to her home in Newcastle where she was examined by a gastrointestinal consultant. The consultant noted that Mrs Morningside was pale and tachycardic. Her blood pressure was 130/90 mmHg. Rectal examination revealed frank melaena. He attributed the bleed to chronic peptic ulceration, probably as a consequence of long-term use of non-specific anti-inflammatory drugs. He considers her to be at high risk of re-bleeding and may contemplate partial gastrectomy when her nutritional intake has improved. The consultant refers Mrs Morningside to the dietitian as he is concerned about her overall nutritional status. She is currently anaemic (frank iron and possibly megaloblastic/pernicious anaemia). (1) Explain the approaches that may be taken to assess this patient's nutri- tional and dietary status. (2) Consider the dietary assessment more carefully. What may be the prin- cipal focus of the interview with the client? What advance preparation might assist you in the conduct of the assessment interview?

Answer 1

In order to assess the nutritional status of the patient, the nurse needs to understand the anthropometric measurements of the patient by:

• The physical examination helps to understand the physical appearance of the patient and to find out the BMI.
• Monitoring the intake and output chart helps to understand the nutritional status of the patient.
• Monitoring the weight helps to understand the accurate weight loss of the patient.

How to depict the information?

The patient is having chronic peptic ulceration so, the focus of the dieticians during the interview must be the collection of history about the previous intake of the anti-inflammatory medications.

In order to confirm it, the dietician needs to ask the patient about the past medical condition and treatments.

As an advance preparation, the dieticians need to study the case sheets of the patient to get an idea about the patient prior to the interview session.

The principal focus of the interview with the client will be the food that the client normally eats and previous treatment regarding the illness.

The advance preparation that might assist in the conduct of the assessment interview is to read extensively on the disease in order to have more information about it.

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