# nutrition

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Jonathan, a two-and-a-half-year-old, lives with his mother and brothers at his grandmother's house in Chicago. His mother, Anita, works at a pharmacy to support the family. Jonathan spends his days at home with his grandmother. While Anita works, his grandmother brings the boys to a nearby congregate W.I.C (Women, Infants, and Children Program) site for a hot meal. Jonathan's favorite foods are french fries and strawberry milkshake. He drinks about four glasses (32 ozs.) of whole milk per day. He also loves grilled cheese sandwiches.

At his W.I.C appointment, the nutritionist asks Anita about Jonathan's food intake and plots his weight and height on growth charts for her to see. She works with Anita on goals for improving Jonathan's nutritional status. The statistics are as follows:

Date of W.I.C Appointment Jonathan's Age Jonathan's Height Jonathan's Weight Lab Values: Hemoglobin Lab Values: Lead
8/1/05 30 months 35.5 inches 27 lbs 10.3 10.2
5/2/05 27 months 35 inches 26.5 lbs
2/4/05 24 months 34.5 inches 26 lbs

Based on the information in Jonathan's case study, complete the following tasks:

Step 1: Assessment of nutritional status.

Your first step is to evaluate the anthropometric and biochemical data that is provided in the table above. Do this using the CDC growth grids for infant boys from the day of their birth until they are 36-months-old. Plot Jonathan's weight/age, length/age and weight/length in a graph.

1.What do you notice about Jonathan's rate of growth over the past six months?

Note: The growth charts can be found in the Appendix of the textbook Foundations and clinical applications of nutrition: A nursing approach.

Step 2: Identify nutritional risk factors.

Nutritional risk factors are any conditions that place a person at risk for malnutrition. The risk may be related to the patient's age, weight, lab values, diet, economics, etc.

Using nursing diagnoses related to nutrition, if possible, (see NANDA in your text) list all of Jonathan's nutritional risk factors. Identify additional risk factors that are not on the NANDA list.

Indicate which of his nutritional problems are identified in Healthy People 2020: Nutrition and Weight Objectives.

Note: The Healthy People 2020: Nutrition and Weight Objectives can be found by going to the following web site:"

Step 3: Identify nursing interventions.

1.What are the possible nursing interventions directed at Jonathan's nutritional risk factors?

2.What diet recommendations would you explore with Anita? Is milk a good source of iron? What are the nutritional imbalances that might be associated with the milk intake? Can you make recommendations that would improve his calorie, iron, and zinc intake? How would this affect his lead absorption?

3.Would you make any healthcare referrals on his behalf?

Step 4: Monitor outcomes.

1.What outcomes would you like to see?

2.What would be a reasonable time frame to monitor intervention outcomes?

• nutrition -

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