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?

Step 1: Assessment of nutritional status.

To evaluate Jonathan's growth over the past six months, we need to plot his weight/age, length/age, and weight/length on the CDC growth grids for infant boys. The growth charts can be found in the Appendix of the textbook "Foundations and Clinical Applications of Nutrition: A Nursing Approach."

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

By comparing the plotted data points on the growth charts, we can visually analyze Jonathan's growth patterns. We may observe whether his weight, length, or weight-to-length ratio falls within the expected range for his age. If there is a significant deviation from the expected growth pattern, it may indicate a potential nutritional issue.

Step 2: Identify nutritional risk factors.

Nutritional risk factors are conditions that increase the risk of malnutrition. These factors can include age, weight, lab values, diet, economics, and more. Using nursing diagnoses related to nutrition, such as those listed in the NANDA (North American Nursing Diagnosis Association) text, we can identify Jonathan's nutritional risk factors. Additionally, we should consider any additional risk factors not on the NANDA list.

We should also identify if any of Jonathan's nutritional problems align with the Healthy People 2020: Nutrition and Weight Objectives. This information can be found on the Healthy People 2020 website.

Step 3: Identify nursing interventions.

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

Based on the identified nutritional risk factors, nursing interventions may include:

- Collaborating with a registered dietitian to develop a personalized nutrition plan for Jonathan.
- Educating Anita and Jonathan's grandmother on age-appropriate foods, portion sizes, and balanced meals.
- Providing resources and support for Anita to access affordable and nutritious food options.
- Monitoring Jonathan's dietary intake and growth regularly.
- Referring Jonathan to specialized healthcare providers, such as a pediatric nutritionist or speech therapist if there are any concerns about his oral intake.

Regarding diet recommendations for Anita, it would be important to explore alternatives to Jonathan's current food choices. While milk does contain iron, it is not a significant source. Overconsumption of milk can contribute to nutritional imbalances, such as inadequate intake of iron and zinc. Recommendations may include introducing a variety of nutrient-dense foods and expanding Jonathan's food preferences.

Improving Jonathan's calorie, iron, and zinc intake may help mitigate the risk of malnutrition. However, it is also important to consider the effect on his lead absorption. Lead exposure can occur through contaminated food or water. If Jonathan's lead levels are a concern, interventions to reduce lead exposure should also be implemented.

Regarding healthcare referrals, if Jonathan's nutritional issues persist or worsen despite interventions, it may be necessary to refer him to specialists such as a pediatrician or pediatric gastroenterologist to further investigate the underlying causes.

Step 4: Monitor outcomes.

1. What outcomes would you like to see?

Desired outcomes may include:

- Improvement in Jonathan's growth parameters (weight/age, length/age, weight/length) to fall within the expected range for his age.
- Achievement of appropriate developmental milestones for his age.
- Maintenance or improvement in relevant lab values (hemoglobin, lead levels).

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

The time frame for monitoring intervention outcomes may vary depending on the specific interventions implemented and the rate of expected growth. It is recommended to schedule follow-up appointments every few months to assess the impact of interventions on Jonathan's growth and nutritional status.