NR 228 Week 8 Older Adult Nutrition Care Plan Example

Nutrition Care Plan: Two Problems, Four People and One Glass of Chocolate Milk for an 83-Year-Old Widower Losing Weight

Student Name

College of Nursing, Chamberlain University

NR 228: Nutrition, Health & Wellness

Instructor Name

Month Day, Year

Nutrition Care Plan: Two Problems, Four People and One Glass of Chocolate Milk for an 83-Year-Old Widower Losing Weight

The Assessment

This plan continues the case of Mr. Henry B., 83, from the Week 4 life stage paper. He is a retired carpenter living alone since his wife died in January. His weight is 66 kilograms, six kilograms lighter than twelve months ago, close to 8% of his body weight. His upper denture is loose and will be relined in two weeks; until then he eats only soft food. A two-day recall showed about 45 grams of protein a day and very little fluid apart from morning coffee. His medicines are an antihypertensive and a daily aspirin; neither is known to reduce appetite. His last blood tests showed normal kidney function. He shops once a week and has never cooked. His only daughter is a two-hour drive away and phones him each Sunday. Details are composite.

As the Week 4 paper set out, the target used here is the PROT-AGE group's figure for adults past 65, a daily minimum somewhere between 1.0 and 1.2 grams for each kilogram he weighs (Bauer et al., 2013), which sits well above the 0.8 g/kg allowance set for all adults (Institute of Medicine, 2005). For Mr. B., that means about 66 to 80 grams a day.

Two Problems, Not Eight

Problem 1: Protein and energy intake below his needs, as shown by a protein intake of about 45 grams a day against a target of at least 66, and a weight loss of 6 kilograms in a year, related to a loose denture limiting what he can chew and to not knowing how to cook.

Problem 2: Low fluid intake, as shown by fluid limited mostly to morning coffee and dark urine in the afternoons, related to reduced thirst with age and to not thinking about drinking.

Both statements could turn out false. If a three-day recall showed 70 grams of protein, the first problem would be wrong, and the weight loss would need another explanation. That is the point of writing them this way: they can be checked.

Goals With Food in Them

Goal 1: by the end of week two, Mr. B. eats at least 66 grams of protein on five of seven days, by his daughter's Sunday recall, through a daily pattern of two eggs at breakfast, a cup of cottage cheese or Greek yogurt at lunch, a glass of chocolate milk in the afternoon, and bean soup or a delivered meal at supper.

Goal 2: by the end of week one, he drinks a glass of water or milk with each meal and one between meals, and his afternoon urine is pale yellow on at least five days, by his own check.

Goal 3: by the four-week provider visit, his weight has stopped falling, measured each Monday on his bathroom scale.

Splitting the Work

Four people share the plan, and each has one job. Mr. B. eats the pattern above, fills a glass at each meal, and writes his Monday weight on the kitchen calendar. His daughter orders groceries for delivery each Friday from a fixed list, eggs, cottage cheese, yogurt, milk, chocolate syrup, canned beans, soup and soft bread, and asks on Sunday what he ate yesterday. The county's home-delivered meals program brings a hot lunch on weekdays, prepared soft until his denture is relined. His dentist relines the denture on the 14th. His primary care provider sees him in four weeks and reviews his weight, his mood and any other cause for the weight loss.

Nothing in the plan asks Mr. B. to cook anything more complicated than eggs in the microwave. That is deliberate: a plan that depends on a skill he does not have would fail in the first week, and he would conclude that the problem was him.

The Marker and the Date

Three markers tell whether the plan works, each with a date. The Sunday recall at the end of week two shows whether the protein goal is being met. The urine check each afternoon and his daughter's question about drinking show the fluid goal by the end of week one. And the Monday weight, written on the calendar, shows the result that matters most, with the four-week provider visit as the point at which the whole plan is reviewed. If his weight is still falling at four weeks despite meeting the protein goal, the plan has done its part and something else is going on, which the provider will need to look for.

What the Plan Deliberately Leaves Out

The plan has only two problems because Mr. B. can manage only a few changes at once, and because the two chosen are the ones that feed his weight loss most directly. Several other things were considered and left out. His calcium and vitamin D needs are higher at his age, but the dairy foods chosen for protein already move both in the right direction, and a supplement is his provider's decision. His sodium intake from canned soup is probably high, and for a man on a blood pressure medicine that matters, but asking him to switch to low-sodium soup in the same week he is asked to eat more would add a restriction to a plan whose purpose is to get him eating; it can come later, once his weight is stable.

The plan also leaves out a formal dietitian referral for now, because the meals program has a dietitian who reviews each client's needs on enrollment, and because a clinic visit is another trip he would have to drive to. If the four-week review shows little progress, a home visit from a dietitian would be the next step.

The Food That Stays

Some foods stay in the plan because he wants them, not because they are ideal. His morning coffee with milk stays; it is the one thing he says he looks forward to, and the milk adds a little protein. The chocolate milk stays, and was his idea: it reminds him of his childhood and he said he would drink it every afternoon. The Sunday pancakes his neighbor brings over after church stay too, because they come with company. A plan that removed every food he enjoys in the name of protein would leave him eating alone, from a list, food he does not like, which is how the weight loss started. Keeping those foods is part of the plan, not a concession to it.

References

Bauer, J., Biolo, G., Cederholm, T., Cesari, M., Cruz-Jentoft, A. J., Morley, J. E., Phillips, S., Sieber, C., Stehle, P., Teta, D., Visvanathan, R., Volpi, E., & Boirie, Y. (2013). Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the PROT-AGE Study Group. Journal of the American Medical Directors Association, 14(8), 542-559. https://doi.org/10.1016/j.jamda.2013.05.021

Institute of Medicine. (2005). Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. The National Academies Press. https://doi.org/10.17226/10490