NR 228 Discussion 6 Latest 2023 / 2024
Jordan is a 14 year old middle school student, weighing 275 pounds and is 5’6” tall. Over the past 2 years, he has gained 60 pounds, as he has begun to withdraw from social activities, and avoid other students, due to bullying from others his age about his weight/appearance. Lately, Jordan has been missing a great deal of school too, particularly on the days he has gym. Jordan’s parents are both average in height and weight, and Jordan’s mother says that he just takes after his grandfather William, who “was a husky man, and died of a sudden heart attack at the age of 44”. She says “We just have fat genes in the family; you can’t do anything about that”!
He has been told he had “no willpower, or is weak, or that he needed to change his lifestyle, eat less and exercise more.” Jordan says “I go for a couple days without eating, but then I get so hungry that I could eat the couch”!
Jason has recently been diagnosed with gallbladder disease and has symptoms that typically occur after eating that include mild pain in the mid-epigastric region, radiating to the right upper quadrant of the abdomen and right subscapular area of the body.
You are the nurse assigned to Jason.
- What would you include in your initial assessment data based on the scenario provided? 1 / 2
The first thing I would do would be confirm the diagnosis with an ultrasound scan. I would also assess his diet and physical activity. I would ask him to keep a diet and exercise journal so that I could assess this more closely on the follow-up visit.
- What would you teach Jordan based on the RDA Recommended Daily Allowance from
the choosemyplate.gov link discussed in lesson 1, and the information provided about gallbladder disease provided in lesson 6?
I would teach him not to try to lose weight too quickly because that can exacerbate the issue.Next, I would help him plan a diet that includes a lot of fibrous foods, like oatmeal and brown rice, and healthy fats, like the kind you get from fish and olives, because they are beneficial to the gallbladder by increasing contraction. I would also encourage him to eat less sugar and refined grains.
- Based on your assessment data and the information from the scenario what might be two
high priority Nursing Diagnosis to guide Jason’s plan of care?
The highest priority would be changing his diet to improve gallbladder function and decrease his chances of developing cholelithiasis. Secondly, I would encourage exercise, which will improve his physical health and also decrease his chances of developing cholelithiasis.
References
Grodner, M., Roth, S. L., Walkingshaw, B. C., & Grodner, M. (2012). Nutritional foundations and clinical applications: A nursing approach (6th ed.). St. Louis, MO: Mosby/Elsevier.
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