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Running head: NUTRITIONAL CASE STUDIES
Nutrition Case Studies: Coagulant Medications and Intermittent Enteric Feedings
Patra D. Cain
University of South Florida
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NUTRITIONAL CASE STUDIES
A patient, Mr. Tobias, has been diagnosed with chronic atrial fibrillation (A-Fib) and the
patient’s doctor has prescribed anticoagulant therapy specific to the A-Fib. Given this new
medication, the patient will need diet teaching. According to Adams, Holland Jr., and Urban
(2013), Mr. Tobias will have to start utilizing a healthy diet of low-fat food choices and decrease
his caffeine and alcohol intake. Mr. Tobias will also need to cease smoking if he does.
Furthermore, the patient should avoid increases and decreases in vitamin K foods. Those foods
include broccoli, cabbage, kale, cauliflower, asparagus, etc. In addition to keeping those vitamin
K foods in mind, the patient should not consume supplement or protein drinks that have added
vitamin K (Adams et al., 2013).
Mr. Tobias will also have to avoid certain over the counter medications along with
nutritional supplement. According to Adams et al. (2013), nutritional supplements the patient
will need to avoid include ginger, garlic, green tea, feverfew, or ginkgo especially while on
warfarin therapy. The patient should always consult his health care provider before using any
over the counter medication but there are a few that the patient should always avoid. Those
include: nonsteriodal anti-inflammatory drugs (NSAIDs), diuretics, selective serotonin reuptake
inhibitors (SSRIs), and other antidepressants, steroid, antibiotics, and vaccines (Adams et al.,
2013).
The reason the patient, Mr. Tobias, cannot take certain over the counter medications is
because the over the counter medications can interfere with the prescription drug he has to take
for his A-Fib. According to Adams et al. (2013), the over the counter medications can bind to the
proteins that the anticoagulant could need to bind to resulting in less effectiveness of the
anticoagulant. The nutritional supplements can increase the patient’s for have the adverse effect
of abnormal bleeding especially while on warfarin therapy (Adams et al., 2013).
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NUTRITIONAL CASE STUDIES
A home health nurse visited a patient who had a tracheotomy tube and had been on
mechanical ventilation at home for several months. The patient’s family had been delivering
intermittent enteric feedings through the PEG tube daily. The nurse would need to look for signs
and symptoms of malnutrition to make sure that the patient is receiving adequate amounts of
nutrition. According to Holleran, Osborn, Watson, and Wraa (2013), signs and symptoms would
be that the patient’s hair is dull, sparse, brittle, and dyspigmented. The face of the patient may
have a puffy or moon shape with temporal wasting and a change in color. The patient’s eyes will
be sunken in, have a pale conjunctive, and fatty deposits around the lids. The patient will have
cracked corners at the mouth, a magenta colored tongue, spongy, bleeding gums, lack of taste,
and an enlarged thyroid. The patient’s skin will be dry and scaly, have bruises, pinpoint
hemorrhage, and photosensitive symmetric rash. The patient will have breading on ribs and
bowed legs. There will be a decrease in fat and muscle wasting and loss. The patient may also
experience edema. The patient may be confused, have a headache, and be lethargic (Holleran et
al., 2013).
Objective assessment tools that could be uses to asses for malnutrition include lab tests. It
is first important to have the patient’s nutrition history so that there is a baseline to look back to
when assessing if the patient is experiencing malnutrition. Also, according to Holleran et al.
(2013) when receiving the results of the labs you are able to asses and see if the result fall within
the malnutrition levels and what severity the malnutrition is.
There are a few risk factors for this patient becoming malnutrition. According to
Holleran et al. (2013), those factors include becoming tolerant to the formula, the wrong amount
of formula being administered, and a fluid imbalance occurring. The nurse needs to ensure that
the patient is receiving the adequate amount of formula for the patient’s needs along with if they
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NUTRITIONAL CASE STUDIES
are becoming tolerant to the formula dose they are receiving. Documenting the patient’s intake
and output will also help to ensure that the patient is receiving enough fluids so they do not
become dehydrated (Holleran et al., 2013).
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NUTRITIONAL CASE STUDIES
References
Adams, M. P., Holland Jr., L.N., & Urban, C. Q. (2013). Pharmacology for Nurses: A
Pathophysiologic Approach (4th ed.). (p. 411-413). Upper Saddle River, New Jersey:
Pearson Education, Inc.
Holleran, R., Osborn, K. S., Watson, A. B., & Wraa, C. E. (2013). Medical-Surgical Nursing:
Preparation for Practice (2nd ed.). (p. 159-197). Upper Saddle River, New Jersey:
Pearson Education, Inc.