Clinical nutrition
Produce 2 case study reports of 1250 words on the followin" rel="nofollow">ing two case studies
CASE STUDIES
Actin" rel="nofollow">ing as a clin" rel="nofollow">inical nutrition practitioner you have been asked to see the followin" rel="nofollow">ing two clients.
Client 1: Mr Effiong is a 55-year-old Nigerian man who lives with his wife and three teenage children in" rel="nofollow">in a three bedroom council flat. He works a 12-hour shift as a security guard in" rel="nofollow">in a local warehouse from 8am to 8pm, 6 days a week. He was diagnosed with type 2 diabetes on presentin" rel="nofollow">ing with extreme tiredness and other symptoms of hyperglycaemia, which he attributed to his long workin" rel="nofollow">ing hours and irregular and unhealthy diet. He had been managin" rel="nofollow">ing his symptoms by himself at home for 6 months until his wife in" rel="nofollow">insisted that he saw a doctor. His current weight is 85kg, height 1.64m and waist circumference 99 cm. His blood pressure was 166/88mmHg. He is now takin" rel="nofollow">ing metformin" rel="nofollow">in bd and the relevant biochemistry results from time of diagnosis were:
• Fastin" rel="nofollow">ing glucose 7 mmol/L
• HbA1c 54 mmol/mol
• TC 4.2 mmol/
• HDL 1.1 mmol/L
• LDL 2.2 mmol/L
• TG 0.7 mmol/L
Client 2: Miss Jones is a 19-year-old university student who has mild ileal Crohn’s disease and has been referred to you for her coexistin" rel="nofollow">ing IBS. Her current daily symptoms are moderate abdomin" rel="nofollow">inal pain" rel="nofollow">in and bloatin" rel="nofollow">ing, mild win" rel="nofollow">ind, no urgency, severe sense of in" rel="nofollow">incomplete evacuation and some tiredness. Her bowels open every 2–3 days [Bristol Stool Form Scale (BSFS) T1 or 2, occasionally T5. She is currently prescribed adalimumab and is also takin" rel="nofollow">ing a multivitamin" rel="nofollow">in and min" rel="nofollow">ineral complex. Her weight has in" rel="nofollow">increased from 45.8 kg to 47 kg in" rel="nofollow">in the last 2 weeks and her BMI is 17kg/m2. She runs 6 days a week and is keen to participate in" rel="nofollow">in a half marathon in" rel="nofollow">in 3 months. She reports that she is avoidin" rel="nofollow">ing bread and pasta as they trigger abdomin" rel="nofollow">inal discomfort and bloatin" rel="nofollow">ing. Rich food triggers vomitin" rel="nofollow">ing, onion gives her bloatin" rel="nofollow">ing, lentils give her lots of bloatin" rel="nofollow">ing and win" rel="nofollow">ind and coffee leads to diarrhoea. She is eatin" rel="nofollow">ing regular meals and snacks, but has a very light lunch, as shown below:
Breakfast: One cup of coffee, gluten free (GF) muesli with full fat goat’s milk or two eggs and sultanas
Lunch: Fruit and goat’s milk
Din" rel="nofollow">inner: White rice or potatoes (no skin" rel="nofollow">in) Sweet potato GF pasta Meat or fish and vegetables Leek and garlic used in" rel="nofollow">instead of onion Snacks GF seed bar or apple, grapes, pear, blueberries, mango
Drin" rel="nofollow">inks: One cup of coffee/day, one cup of tea/day, herbal teas, smoothies, water
For each of the above patients, provide a dietary assessment and management plan by usin" rel="nofollow">ing current research and clin" rel="nofollow">inical guidelin" rel="nofollow">ines. Write your clin" rel="nofollow">inical management plan, in" rel="nofollow">includin" rel="nofollow">ing scientific rationale, as a case study report.