My patient is J.W., he is a 60 year old African-American male who identifies as Catholic. J.W. is 6’0” in height and weighs 230lbs.
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The patient is married and has three children. He leads a fairly sedentary lifestyle as he travels three days a week for work and tends to eat out three meals per day. His current diet consists of high calorie fast food which is low in nutrients. The patient has been diagnosed with hypertension (HTN), and dibetes mellitus type to (DM2) and his doctor has recommended that he lose one pound per week for three months in order to help him achieve a healthy weight. Medications that J.W. is currently taking are Metformin 500mg twice a day, Metropolol 200mg once daily as well as a multivitamin. J.W.’s body mass index is at 31.2 which categorizes him as obese. For a male of his height, the BMI chart recommends that he should weight between 140lbs-180lbs in order to be considered healthy (aim for healthy weight 2018).
J.W. stated that he eats fast food three times a day, and although there are some healthy choices that can be made when eating out, most people opt for the less healthy options. Based on what Americans commonly eat in fast food restaurants, such as burgers and fries with say, a coke, J.W.’s diet is high in fat, cholesterol, sodium, and sugar. There is definitely some protein in there, however, fat, cholesterol and sodium far outweigh the amount of protein. In order for J.W. to achieve the one pound weight loss per week, he will have to learn what the healthier options are at the places he eats and stick to those when eating on the go. Restaurants such as Subway offer healthier options. They serve egg white omelets for breakfast and lean meats or veggie subs for lunch. McDonalds and Starbucks offer oatmeal for breakfast, chicken wraps, and chicken salads as their healthier options. One of the most popular now, Chick-Fil-A offers a variety of salads as well as skinless grilled nuggets and chicken strips. Panera also has some sensible meals, soup or salad and a sandwich for lunch for example (fast food places that serve healthy foods). Most people in our society today are always on the go and it is less likely that we eat homecooked meals every day, which is why it is important that we educate patients on proper nutrition even when having to eat out often.
Micronutrients are defined as “nutrients that are needed in small amounts” (Dudek, 2018), these are our vitamins and minerals. Vitamins A, D, E, and K, are fat soluble vitamins. Since these are not easily excreted through urine and so it is important to take only what is needed to avoid toxicity (Dudek 2018). Vitamin A aids with eyesight, bone development, teeth development, immune function, and promotes healthy skin and hair (Dudek, 2018). Due to the foods that J.W. eats such as the beef in cheeseburgers, it is unlikely that he would develop a deficiency in vitamin A. There are however healthier options such as fruits and vegetable by which he can obtain the needed amount of vitamin A. Carrots and sweet potato are known to be a great source of vitamin A. Vitamin D is extremely important in bone development. Vitamin D comes from sunlight, oil, milk, fish, egg yolks, and liver (Dudek 2018). A deficiency in vitamin D could cause hormonal imbalances, affect bone growth and density, decay teeth, and negatively affect absorption in the GI tract (Dudek 2018). If vitamin D levels drop low enough, the patient could experience muscle twitches, tingling around the mouth and tingling in the distal extremeties (Dudek 2018).
Since J.W. travels for work, I suspect he does not spend much time in the sunlight. Also, because J.W. is African American, he would need to be in the sunlight for a prolonged amount of time in order fully benefit. It is very likely that J.W. is deficient in vitamin D or at the very least he has a low level of vitamin D. A deficiency in vitamin E, although rare, can cause a patient to be anemic, swollen or produce skin lesions (Dudek 2018). Foods that provide vitamin E are vegetable oils, leafy green vegetables, whole grains, and nuts (Harvard Health Publishing). With the description of J.W.’s diet, I would suspect that his vitamin E is on the lower end. Finally, vitamin K aids in clotting of the blood. Some foods that provide vitamin K cabbage, eggs, milk, spinach, broccoli, and kale (Harvard Health Publishing), again, I would suspect that J.W. is also deficient in vitamin K or at least has low levels of vitamin K. Because J.W. does have hypertension, he also needs to monitor his sodium level intake. The recommended daily intake of sodium is 2300mg. This number should be greatly reduced due to J.W.’s age and condition. J.W. should consume no more than 1500mg of sodium per day (Shaking the salt habit to lower blood pressure, 2019).
J.W. has been diagnosed with two major conditions, type 2 diabetes, and hypertension. Hypertension has both modifiable factors and non modifiable factors (Nutrition ATI). Some modifications that J.W. could make to help with his hypertension are to lower sodium consumption, incorporate physical activity at least 30 minutes a day, even if it is just a brisk walk, lose weight, smoking cessation, and adding more fruits and vegetables to his diet (Nutrition ATI). Type two diabetes also has some modifiable risk factors such as exercising and maintaining a healthy weight. According to the American Heart Association, adults with diabetes are more likely to die from heart disease than adults without diabetes. Cardiovascular disease is the number one killer for diabetics (Dudek 2018). Since J.W. leads a very sedentary lifestyle, even light exercise will make a huge difference in his health. As he loses weight and gains endurance, he can aim for higher intensity workouts.
J.W. currently takes Metformin, Metropolol, and a multivitamin. Metformin is used in controlling blood sugar in type 2 diabetes. J.W. should be educated on the effects of Metformin and should monitor his blood glucose levels regularly while on this medication. He should also know the signs and symptoms of hypoglycemia such as pallor, tremors, diaphoresis, palpitations, and anxiety as hypoglycemia could be fatal if not treated effectively (Copstead and Banasik 2013). Metropolol is a Beta-adrenergic blocker used to regulate blood pressure. When taking this medication J.W. should monitor himself for hypotension as it is one of the side effects. According to Copstead and Banasik, this medication could also cause anxiety and heart palpitations. It is important that J.W. talk to his provider about all medications, prescribed and over the counter, in order to prevent any contraindications or sever interactions.
According to Dudek, a diabetic patient should consume 1500-2000 calories per day. In order for J.W. to lose one pound per week, his daily consumption should be as follows:
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