Disease: name of the disease, condition, or surgery you chose from the topic list
Researcher: your full name
Primary cause(s) and description of the disease, condition, or surgery: brief description, why it occurs (if known), and/or the intended outcome of the surgery
Prevalence of the disease in the United States (give statistics and reference): make sure to cite your sources for the statistics; for surgery give statistics on the reason for the surgery and outcomes
Common medications used to treat this disease (list a maximum of three): give the name of a common medication or a class of medications used to treat the disease
Subjective and Objective Findings
Subjective data is the information that the person or patient tells you. An example of subjective data is the pain they are experiencing. Objective data is information that a healthcare provider sees, hears, measures, tests, or feels. Lung sounds are an example of objective data.
This section should include common signs and symptoms of the disease, complaints the patient may have, and findings on test results. Symptoms are subjective and are things the person tells you. Signs are objective and are things that you see. Examples of normal findings are provided for each section.
There should be no areas left blank. If an area is unaffected by the disease, document that the area is not commonly affected.
The person’s general appearance including dress, hygiene, overall strength, ability to walk/ambulate, ability to communicate, and their level of consciousness or awareness.
Head – The head of the client is normocephalic and symmetrical; the face is symmetrical with no lesions or masses present
Eyes – The eyes are symmetrical, the sclera are white, no drainage noted, pupils are equal and react to light. Patient denies any visual changes or vision loss.
Ears – The ears are symmetrical and are aligned with the outer corner of the eye. Patient denies hearing loss or ringing in the ears.
Nose – The nose appeared symmetric, straight and uniform in color. No presence of nasal discharge or flaring. Patient denies any changes in smell and denies tenderness upon palpation.
Throat / Mouth – The lips of the client are pink, moist, and are symmetrical with smiling. Good dentition with no missing teeth. Gums and oral mucosa are pink and moist with no lesions. Patient denies difficulty chewing, swallowing, or speaking.
The chest wall has symmetrical movement with no tenderness or masses. Respirations are nonlabored. Lung sounds are clear upon auscultation. Patient denies any shortness of breath, coughing, or oxygen use.
Cardiovascular: Heart rate has a regular rhythm and rate. Patient denies chest pain or shortness of breath. Capillary refill time is less than two seconds. Color, movement, and sensation are intact in upper and lower extremities. Peripheral pulses are present and equal bilaterally. No peripheral edema is noted.
Abdomen / Gastrointestinal:
The abdomen has a symmetric contour. There were symmetric movements caused associated with client’s respirations. Bowel sounds are present in all four quadrants. Patient denies nausea, vomiting, diarrhea, or constipation.
Patient denies any pain with urination and states they urinate 4 to 5 times per day. If a patient was in the hospital, the urine amount would be measured. Patient denies any changes or difficulty with genitalia.
Patient denies tremors, trembling, spastic movement, changes in sensation, or weakness in extremities. Patient denies any changes in mood, memory, ability to focus, or sleep disturbance.
The extremities are symmetrical in size and length. Muscle strength is equal bilaterally in extremities and movement is coordinated. Joints have full range of movement with no swelling, tenderness, or crepitation.
The skin is pink, warm, and dry with no lesions, masses, or rashes. Patient denies itching or tenderness.
Are there any expected changes in vital signs for this disease? Vital signs include temperature, pulse, respiratory rate, blood pressure, oxygen saturation, and pain level on a scale of 1 to 10. An example would be a patient with hypertension might have an elevated blood pressure or a patient with COPD might have an increased respiratory rate or decreased oxygen saturation.
Lab or radiology tests:
What are common labs done to diagnose this disease or labs that are commonly abnormal for this disease? An example would be an elevated Hemoglobin A1c would be an indication of diabetes, or an x-ray would show joint changes for a patient with arthritis.
Additional physical findings common with this disease:
List any other common findings with the disease that was not addressed above
Review the medications you listed for this condition. List any Food – Drug interactions that are possible:
Example- grapefruit should not be eaten with some statin cholesterol lower drugs
Describe any side effects of the medications that would interfere with the person’s metabolism or eating:
Example – prednisone can lead to weight gain
Describe any side effects of the medications that would affect the person’s nutritional needs:
Example – a person taking Statin drugs may need to take CoQ10 supplements to decrease the potential for muscle pain
Are there any food intolerances, food allergies, or foods that should be avoided with this disease, condition, or surgery:
Example – alcohol should be avoided with pancreatitis.
Will this person need an alternative way be fed now or in the future? If so, how could it be done?
Example – a patient with esophageal cancer may not be able to swallow food and may need to be fed through enteral or parenteral means. (can they swallow food)
Can this person feed themselves now or in the future? If not, how will the patient eat?
Example – stroke patients often lose function of one side of their body so they may have to learn how to use their non dominant hand/arm to feed themselves. (can they use a fork, knife, spoon, etc. and chew their food)
What are common therapeutic or dysphagia diets prescribed for this disease, condition, or surgery?
Example – bariatric surgery patients must start with a clear liquid diet after surgery or stroke patients that have swallowing difficulties may have to have all liquids thickened.
Is it common for this patient to need increased oral nutrition or supplementation? If so, what are some examples of what would be used in a healthcare setting?
Example – failure to thrive patients may need increased calories and protein that can be achieved through drinking nutritional supplements like Ensure.
What food(s) should the patient NOT eat?
What food(s) should the patient eat in limited quantities?
What foods are the patients encouraged to eat?
Summarize your information into one paragraph that provides an overview of your disease, condition, or surgery. Next, provide three Interventions that would be important for the patient. Interventions should be related to nutrition and be something that a nurse or dietitian would accomplish through patient education.
Provide a brief overview of your information. This should be like an abstract of a paper.
- Example – provide education on increasing protein intake to 60 grams per day for bariatric surgery patients
- Example – educate parents on how to prepare food for a failure to thrive baby
- Example – provide high calcium food list for patients with osteoporosis
Provide at least 5 references for your information.
References should be cited throughout your Resource Guide.
APA formatting is required.
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