POLYPHARMACY OF THE ELDERLY: DRUG-NUTRIENT INTERACTIONS Adapted
POLYPHARMACY OF THE ELDERLY: DRUG-NUTRIENT INTERACTIONS Adapted from Medical Nutrition Therapy – A Case Study Approach – Marcia Nahikian Nelms Bob Kaufman, an 85-year-old Caucasian male, has been brought to the hospital emergency room because of a change in his mental status. Mr. Kaufman suffers from several chronic diseases that are currently treated with multiple medications. Sudden onset of confusion over past 24 hours. Lives with daughter for 3 years, daughter cooks all meals except breakfast. Mr. Kaufman is responsible for his own medicine, does his own insulin injections and monitors his blood glucose. Still drives and does volunteer work. Height: 5’8″ Weight: 190 pounds Blood pressure: 160/82 Personal Articles: Eyeglasses, Dentures (upper & lower) Education: High school, 1 year of college Occupation: Retired postal clerk Social History: Lives with daughter (age 45), son-in-law (age 52) and 2 grandsons (ages 11 and 16) Past Medical History (PMHx): CAD, Type 2 DM, renal insufficiency, peripheral neuropathy, osteoarthritis, Hx of prostate CA, diverticulitis/diverticulosis, hypertension Meds: Vasotec, Prilosec, Neurontin, furosemide, isosorbide mononitrate, trazodone, sodium bicarbonate, aspirin, multivitamin, Zocor, NPH and regular insulin Nutrition History: Patient’s daughter states that patient’s appetite is good – “probably too good!” Daughter prepares most meals. Dad snacks between meals, but daughter states that she tries to have low-sugar and low-fat choices available. He weighed almost 235 pounds when he came to live with her and her family almost 3 years ago. His weight has been stable for the past year. Her biggest concern nutritionally is that her father never seems to drink fluids except at mealtime, and she is worried that he doesn’t get enough. “I will pour him a glass of water between meals. He will take one sip, and then he just lets it sit there.” She states that she tries to keep his calories down and limits simple sugars. That is about as far as they go with diabetic restrictions. She states, “I just don’t feel my father will eat anything more restrictive. I figure at 85, we’ll just do the best we can.” Usual dietary intake: Am egg beaters – 12 oz carton scrambled with 1 tbsp shredded cheese, 2 slices bacon, 1 slice toast, 1â„2 cup cranberry juice, 3 c coffee with fat-free creamer. About twice a week, he has corn flakes with a banana and 2% milk for breakfast. Lunch Dinner Snacks usually from the Senior Center – diabetic lunch – 2 to 3 oz meat, 1 to 2 vegetables 1â„2 c each, roll, 1â„2 c fruit, 6 to 8 oz iced tea 3 to 4 oz meat, rice, potato or noodle 1 c, 1 slice of bread, 1â„2 c fresh fruit, 6 to 8 oz iced tea usually 2 to 3 times daily: sugar-free jello, low-fat yogurt, microwave popcorn Diet Prescription (Rx): 1,800 kcal CHO Counting Previous Nutrition Therapy – Yes, when first diagnosed with DM over 15 years ago Hospital Course: Diagnosis – Metabolic alkalosis secondary to excessive intake of sodium bicarbonate; mild dehydration. Patient is receiving NS 40mEq of KCL @75cc/hr for 24 hours. As electrolyte abnormalities resolve, confusion will resolve as well. Patient stated that he was confused with medications. Nutrition consult prior to discharge. Lab Patient’s Value Albumin 3.0 Sodium 149 Potassium 2.8 Glucose 172 BUN 32 Creatinine 1.5 Chol 175 HDL 41 LDL 135 TG 175 HbA1C 8.2 Osmolality 310 pH 7.47 pCO2 46 Normal Value 3.5-5.0 136-145 3.5-5.5 70-110 8-18 0.6-1.2 120-199 >45 <130 40-160 3.9-5.2 285-295 7.35-7.45 35-45 HCO3 32 Hgb 10 Hct 38% MCV 77 24-28 14-18 42-52% 80-95 1. Write nutrition assessment in ADIME format. Make sure to include in your intervention an appropriate diet order for the patient. SCIENCE HEALTH SCIENCE NURSING DFN 348
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