You are asked to see Mr. Basset, who is 80 years old, currently living alone, and has recently lost his wife. His children do not live nearby, but Mr. Basset sees them on holidays. Mr. Basset was recently diagnosed with lung cancer and has had an unexplained weight loss of 20 pounds in 3 months. He is getting chemotherapy as well as taking oral medication for hypertension and arthritis, and is showing signs of dehydration.

Mr. Basset reports that his wife did most of the cooking and he has limited cooking skills. He usually has cereal with milk and coffee for breakfast and soup for a second meal later in the day. He eats crackers throughout the day if he is hungry, but admits that he doesn’t have much of an appetite. In addition, Mr. Basset has ill-fitting dentures and claims that food just does not taste the same. He is also on a limited budget.

1. What physiological factors might contribute to Mr. Basset’s weight loss?

2. What psychosocial factors might contribute to Mr. Basset’s weight loss?

3. Give one likely explanation why Mr. Basset’s dentures do not fit.

4. What nursing actions need to be included in the plan of care to improve Mr. Basset’s nutritional status?

Section 2
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 midepigastric region, radiating to the right upper quadrant of the abdomen and right subscapular area of the body.

You are the nurse assigned to Jason.

1.What would you include in your initial assessment data based on the scenario provided?
2.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?
3.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?