1. We calculate BMI as the weight (in kilograms) over the square of height in meters. However, it can also be calculated using pounds and inches (Cook, Kirk, Lawrenson, & Sandford, 2005). In this case:
BMI=weight in kg/ (height in metres) 2
Weight = 210 lb/95.25 kg
Height = 56
Multiply the height in by 0.025 (metric conversion factor)
= (5x 12) + 6 = 66
2. Screening tools to assess nutritional and exercise knowledge and reasons
The most commonly used and suitable screening tool that is used by most nutrition specialists is the Mini-Nutritional Assessment (MNA). The tools also very relevant for physicians engaging in comprehensive elderly assessment and could appropriately be used in the case study. The tool is appropriate for this because it can be used for both the hospitalized and well to do elderly like in the case study. The questions used in the tool are easy and short and hence can be understood easily (Elia, Zellipou & Stratton, 2005).
Other tools can, however, be used like the Body Mass Index (BMI) that is meant to determine malnutrition and obesity among the elderly. The tool is useful to measure regularly the weight and changes among the elderly like in the case study. Similarly, the patient can appropriately use the Determine Your Nutritional Health Checklist which is very relevant in the community setting as in the case study. The method is also relevant to the patient in the case who is still independent and can do things on her own. In addition, in the home setting like in the case study, the patient can use the amount of food left on the plate to do a self-nutritional assessment (Elia, Zellipour, & Stratton, 2005).
Two client outcomes that are reasonable, measurable and realistic
The situation of the client in the case study is complicated and portrays a number of issues with nutritional assessment. He needs a physician or dietary specialist as soon as possible. Some of the outcomes highlighted by his condition include obesity and vulnerability to chronic illnesses such as diabetes, hypertension and heart diseases.
Three nursing interventions for each client outcome and give rationales
The patient is obese with a BMI of 34 kg/m2. The condition requires the close attention of a physician to help the patient achieve an optimum balance in diet nutritional status and healthy body weight. He also needs his blood sugar levels to be controlled to help in longer morbidity prevention and wound healing. The client needs to swap unhealthy foods such as high-energy foods like fast foods, processed foods, and sugar for the healthier ones. She needs to take plenty of fruits and vegetables, milk and dairy foods and small amounts of drinks with high fat content. The client also needs to avoid foods with high amounts of salt as salt has the effect of raising blood pressure (Sullivan et al., 2004)
Apart from diet, the client needs advice on how to lose weight through exercise. She needs to join local weight loss group or commercial services like a gym that she will pay for. Similarly, a community health team should prescribe the exercise for several sessions under supervision by a qualified trainer. These may include fast walking, jogging, swimming or playing tennis.
Besides, the client needs to set realistic goals on losing weight, for instance losing 5% of her weight after a certain period. She also needs to monitor her progress and involve friends and family with weight loss issues. In addition, the client needs to avoid situations that may result in her overeating.
Vulnerability to chronic illnesses
The clients obesity suggests the risk of chronic illnesses such as heart diseases or diabetes. Information on the cholesterol levels can be used to provide information on the long-term nutritional strategies. Restrictions on use of sodium, fat and cholesterol are handy. In addition to this, there is a need for the client to be educated in both understanding and following dietary advice. He also needs a referral to a community dietician. The key to these interventions is striving to maintain a healthy body weight
The client also needs to maintain a daily physical activity and reduces less involving activities like watching TV. This is because reduced physical activity will go a long way in reducing chronic illnesses such as diabetes, heart failure among others. .
5. Weakness in the clients life and supports may be affecting the clients activity and diet
Some of the weaknesses in the client's life is independence in the daily activates despite the fact that he is obese. This increases the risk of suffering injuries from falls for instance at the shower. Such incidences may lead to injuries like fractures.
In addition, the client has a risk when it comes to his diet. She is too proud of her self-reliance, which may result in arrogance when it comes to diet. This will result in her eating an unbalanced or unhealthy diet that will worsen her situation.
6. Referrals to make and why
I would refer the client to a community dietician. The community dietician will help educate her to follow certain dietary advice that will help in dealing with her obesity. Similarly, the dietician can help with the client discharge planning. The dietician will also develop strategies and local weight management services for the client. In addition, the dietician will help in counseling the client if they do not respond to the initial and given her condition, that requires advice that is more detailed. The dietician is also important to provide update information to the medics, which will be independent and based on evidence. Besides, the dietician will help in following up the patients condition and bring it to manageable levels.
In addition to a dietician, I would refer the client to a physic to help her with exercise. Egocentric patients such as the client are sometimes difficult to deal with and therefore, it is recommended that she see a physic help her with physical exercises to help reduce weight. The physic will also come up with a program that the client will be required to follow in order to manage her condition effectively.
Cook, Z., Kirk, S., Lawrenson, S., & Sandford, S. (2005). Use of BMI in the assessment of undernutrition in older subjects: reflecting on practice.Proceedings of the Nutrition Society, 64(03), 313-317.
Elia, M., Zellipour, L., & Stratton, R. J. (2005). To screen or not to screen for adult malnutrition?. Clinical Nutrition, 24(6), 867-884.
Sullivan, D. H., Liu, L., Roberson, P. K., Bopp, M. M., & Rees, J. C. (2004). Body weight change and mortality in a cohort of elderly patients recently discharged from the hospital. Journal of the American Geriatrics Society,52(10), 1696-1701.
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