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Clinical Cases in Dietetics

ISBN: 978-1-4443-0745-0
296 pages
March 2009, Wiley-Blackwell
Clinical Cases in Dietetics (1444307452) cover image
Learning how to deal with actual cases and developing the ability to arrive at a reasoned clinical judgement are important parts of a student's training.


This unique text presents a series of clinical cases of increasing complexity and range. Readers are taken through a structured way of thinking that facilitates clinical reasoning and the arrival of a justified treatment plan. Each case includes a commentary and opportunities for reflection on practice, and identifies key learning points.

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The introduction 1

The cases (and contexts) 15

Case 1 Gillian Mercer 17
Diabetes
Case 2 The Odessa fi le 18
Renal disease, haemodialysis
Case 3 Darshan 19
Renal disease, peritoneal dialysis
Case 4 Professor Plum 20
Renal disease, pre-dialysis
Case 5 Annie 21
Renal disease, pre-dialysis
Case 6 Jon 23
Obesity
Case 7 Mr Smart 24
Obesity, renal calculi
Case 8 Susan Ritzio 25
Ulcerative colitis
Case 9 Mr Rodger 26
Irritable bowel syndrome
Case 10 Pauline Trotter 27
Obesity, pharmacological management
Case 11 Harriet Baker 28
Obesity, metabolic issues
Case 12 Mr Cunningham 29
Functional dyspepsia, weight loss
Case 13 Mrs Rose Petroni 30
Obesity, infection, wound healing
Case 14 Linda Middlemiss 31
Arthralgia, food intolerance
Case 15 Josh Herriot 32
Coeliac disease, new diagnosis
Case 16 Carly Carpenter 33
Disordered eating in adulthood
Case 17 Mr Tony Marshall 34
Obesity, renal calculi
Case 18 Carrie West 35
Bulimia nervosa
Case 19 Holly Shakespeare 36
Obesity, polycystic ovarian syndrome
Case 20 Barry Morgan 37
Post-surgical weight loss, appetite failure
Case 21 Rayan Hussein 39
Iron-deficiency anaemia, ethnic diet
Case 22 Peggy 40
Dementia
Case 23 Cain 41
Cerebral palsy
Case 24 Abel 42
Down's syndrome
Case 25 Lucinda Smythe 45
Reactive hypoglycaemia
Case 26 Mrs Jolly 46
Type 2 diabetes
Case 27 Cordelia 47
Irritable bowel syndrome
Case 28 Josh 48
Human immunodefi ciency virus (HIV)
Case 29 Murdo MacKenzie 49
Cardiovascular and colorectal cancer risk
Case 30 Anna Walker 50
Bone health
Case 31 Shirley Stringfellow 51
Angioedema, salicylate exposure
Case 32 Family tree 52
Diet and lifestyle change over time
Case 33 RMS Titanic 53
Dietary judgement of menus
Case 34 Maria von Twigg 56
Anorexia nervosa
Case 35 Alan Wanderlust 57
Colorectal cancer
Case 36 George and Dragon 58
Dementia, weight loss
Case 37 Mandy Morton 59
Ventilated patient, enteral feeding
Case 38 Betty Meldrew 60
Breast cancer, weight loss
Case 39 Sheila Borrowman 61
Chronic pancreatitis, diabetes
Case 40 Miss Taylor 62
Cancer of lung, cachexia
Case 41 Mary Glover 63
Coeliac disease, lymphoma
Case 42 Pamela Nightingale 64
Chronic fatigue syndrome
Case 43 Jenny Friel 65
Crohn's disease
Case 44 Alan Lehman 66
Type 1 diabetes
Case 45 Mark 67
Attention deficit hyperactivity disorder
Case 46 Mary Montgomery and Mary Hamilton 68
Oral pathology, nutritional issues
Case 47 Sara Bloomfield 69
Chronic obstructive airways disease
Case 48 Jonny Morgan 70
Thinness, faulty diet and health risk
Case 49 Patrick Foley 71
Burn injury
Case 50 Doris Blessing 72
Type 2 diabetes, pressure sore
Case 51 Rupert St. John Stevens 74
Alcoholic liver disease
Case 52 Mrs Morningside 75
Chronic peptic ulceration
Case 53 Mandy Goodenough 76
Gestational diabetes
Case 54 Mrs Jessie Banks 77
Renal disease, type 2 diabetes
Case 55 Toby Harris 80
Fractured mandible
Case 56 John Thomson 81
Motor neurone disease
Case 57 Daisy Marsden 82
Alcoholic liver disease
Case 58 Freda Ingram 84
Obesity, cognitive behavioural therapy
Case 59 Susan O'Connel 85
Crohn's disease, anorexia
Case 60 Dominic Pruz 87
Ulcerative colitis, loop ileostomy
Case 61 Rudi Jordache 88
Obesity, behaviour modifi cation
Case 62 Glenda Henderson 90
Gestational diabetes, obesity
Case 63 Daniel Borden 91
Head injury, nutritional support
Case 64 Shaun Gascoine 92
Oesophageal carcinoma
Case 65 Frank Calder 94
Type 1 diabetes, overweight
Case 66 Stanislaw Roza 95
Hypertension, ethnic diet, health risk
Case 67 Peter Donnelly 96
Overweight, hypertension
Case 68 John Mortimer 98
Stroke
Case 69 Maude Ashby 99
Stroke, clinical chemistry
Case 70 Christopher Smith 100
Terminal cancer, palliative care

The diaries (and contexts) 103

Diary 1 Weight loss, diet patterns 105
Diary 2 Migraine, diet exclusion 106
Diary 3 Type 2 diabetes, diverticulitis 108
Diary 4 Irritable bowel syndrome 109
Diary 5 Coronary artery disease, health risk 110
Diary 6 Hypertension, renal calculi 111
Diary 7 Reactive hypoglycaemia 113
Diary 8 Bowel habit, dietary influences 114
Diary 9 Constipation, hunger 116
Diary 10 Obesity 117

The referrals (and contexts) 119

Referral 1 Letter 121
Mrs Brown (managing serum cholesterol levels)
Referral 2 Letter 122
Ms Philpott (irritable bowel syndrome)
Referral 3 Letter 123
Mrs Young (obesity, confl ict with medications)
Referral 4 Letter 124
Mrs Leadbetter (coeliac disease, iron-defi ciency anaemia)
Referral 5 Letter 125
Mr Grant (obesity, hypothyroidism)
Referral 6 Letter 126
Ms Horvig (abdominal pain, elimination diet)
Referral 7 Nutritional screening 127
Mr Al-Khatim, Room 221 (prostatic cancer, chemotherapy)
Referral 8 Nutritional screening 129
Mrs Collins, Room 401 (anterior resection of bowel)
Referral 9 Nutritional screening 131
Mr Roundman, Room 613 (type 1 diabetes, infection)
Referral 10 Handwritten note 133
Mrs Lundquist, Room 408 (gestational diabetes)

The mini-cases (and contexts) 135

Mini-case 1 Multiple sclerosis, obesity 137
Mini-case 2 Anterior resection of bowel 137
Mini-case 3 Obesity, weight control 137
Mini-case 4 Obesity, nutritional screening 137
Mini-case 5 Coeliac disease, peer-reviewed information 138
Mini-case 6 Type 2 diabetes, dietary compliance 138
Mini-case 7 Obesity, aggressive weight loss 138
Mini-case 8 Hip replacement, nutritional status 138
Mini-case 9 Unconscious patient, feeding issues 139
Mini-case 10 Weight loss, older client 139

The commentaries 141

The commentaries: the cases 143

Case 1 Gillian Mercer 143
Diabetes
Case 2 The Odessa fi le 144
Renal disease, haemodialysis
Case 3 Darshan 145
Renal disease, peritoneal dialysis
Case 4 Professor Plum 145
Renal disease, pre-dialysis
Case 5 Annie 146
Renal disease, pre-dialysis
Case 6 Jon 148
Obesity
Case 7 Mr Smart 149
Obesity, renal calculi
Case 8 Susan Ritzio 150
Ulcerative colitis
Case 9 Mr Rodger 150
Irritable bowel syndrome
Case 10 Pauline Trotter 151
Obesity, pharmacological management
Case 11 Harriet Baker 152
Obesity, metabolic issues
Case 12 Mr Cunningham 153
Functional dyspepsia, weight loss
Case 13 Mrs Rose Petroni 153
Obesity, infection, wound healing
Case 14 Linda Middlemiss 154
Arthralgia, food intolerance
Case 15 Josh Herriot 155
Coeliac disease, new diagnosis
Case 16 Carly Carpenter 156
Disordered eating in adulthood
Case 17 Mr Tony Marshall 158
Obesity, renal calculi
Case 18 Carrie West 159
Bulimia nervosa
Case 19 Holly Shakespeare 160
Obesity, polycystic ovarian syndrome
Case 20 Barry Morgan 161
Post-surgical weight loss, appetite failure
Case 21 Rayan Hussein 161
Iron-defi ciency anaemia, ethnic diet
Case 22 Peggy 162
Dementia
Case 23 Cain 163
Cerebral palsy
Case 24 Abel 164
Down’s syndrome
Case 25 Lucinda Smythe 165
Reactive hypoglycaemia
Case 26 Mrs Jolly 166
Type 2 diabetes
Case 27 Cordelia 167
Irritable bowel syndrome
Case 28 Josh 168
Human immunodefi ciency virus (HIV)
Case 29 Murdo MacKenzie 169
Cardiovascular and colorectal cancer risk
Case 30 Anna Walker 170
Bone health
Case 31 Shirley Stringfellow 171
Angioedema, salicylate exposure
Case 32 Family tree 172
Diet and lifestyle change over time
Case 33 RMS Titanic 172
Dietary judgement of menus
Case 34 Maria von Twigg 173
Anorexia nervosa
Case 35 Alan Wanderlust 174
Colorectal cancer
Case 36 George and Dragon 174
Dementia, weight loss
Case 37 Mandy Morton 175
Ventilated patient, enteral feeding
Case 38 Betty Meldrew 176
Breast cancer, weight loss
Case 39 Sheila Borrowman 177
Chronic pancreatitis, diabetes
Case 40 Miss Taylor 178
Cancer of lung, cachexia
Case 41 Mary Glover 179
Coeliac disease, lymphoma
Case 42 Pamela Nightingale 179
Chronic fatigue syndrome
Case 43 Jenny Friel 180
Crohn's disease
Case 44 Alan Lehman 181
Type 1 diabetes
Case 45 Mark 181
Attention deficit hyperactivity disorder
Case 46 Mary Montgomery and Mary Hamilton 182
Oral pathology, nutritional issues
Case 47 Sara Bloomfi eld 183
Chronic obstructive airways disease
Case 48 Jonny Morgan 184
Thinness, faulty diet and health risk
Case 49 Patrick Foley 185
Burn injury
Case 50 Doris Blessing 186
Type 2 diabetes, pressure sore
Case 51 Rupert St. John Stevens 187
Alcoholic liver disease
Case 52 Mrs Morningside 188
Chronic peptic ulceration
Case 53 Mandy Goodenough 189
Gestational diabetes
Case 54 Mrs Jessie Banks 190
Renal disease, type 2 diabetes
Case 55 Toby Harris 191
Fractured mandible
Case 56 John Thomson 192
Motor neurone disease
Case 57 Daisy Marsden 193
Alcoholic liver disease
Case 58 Freda Ingram 194
Obesity, cognitive behavioural therapy
Case 59 Susan O’Connel 195
Crohn’s disease, anorexia
Case 60 Dominic Pruz 195
Ulcerative colitis, loop ileostomy
Case 61 Rudi Jordache 196
Obesity, behaviour modifi cation
Case 62 Glenda Henderson 197
Gestational diabetes, obesity
Case 63 Daniel Borden 198
Head injury, nutritional support
Case 64 Shaun Gascoine 199
Oesophageal carcinoma
Case 65 Frank Calder 200
Type 1 diabetes, overweight
Case 66 Stanislaw Roza 201
Hypertension, ethnic diet, health risk
Case 67 Peter Donnelly 202
Overweight, hypertension
Case 68 John Mortimer 204
Stroke
Case 69 Maude Ashby 205
Stroke, clinical chemistry
Case 70 Christopher Smith 206
Terminal cancer, palliative care

The commentaries: the diaries 209

Diary 1 Weight loss, diet patterns 209
Diary 2 Migraine, diet exclusion 209
Diary 3 Type 2 diabetes, diverticulitis 210
Diary 4 Irritable bowel syndrome 210
Diary 5 Coronary artery disease, health risk 211
Diary 6 Hypertension, renal calculi 211
Diary 7 Reactive hypoglycaemia 212
Diary 8 Bowel habit, dietary infl uences 213
Diary 9 Constipation, hunger 213
Diary 10 Obesity 214

The commentaries: the referrals 215

Referral 1 Letter 215
Mrs Brown (managing serum cholesterol levels)
Referral 2 Letter 216
Ms Philpott (irritable bowel syndrome)
Referral 3 Letter 216
Mrs Young (obesity, confl ict with medications)
Referral 4 Letter 217
Mrs Leadbetter (coeliac disease, iron-defi ciency anaemia)
Referral 5 Letter 218
Mr Grant (obesity, hypothyroidism)
Referral 6 Letter 219
Ms Horvig (abdominal pain, elimination diet)
Referral 7 Nutritional screening 220
Mr Al-Khatim, Room 221 (prostatic cancer, chemotherapy)
Referral 8 Nutritional screening 220
Mrs Collins, Room 401 (anterior resection of bowel)
Referral 9 Nutritional screening 221
Mr Roundman, Room 613 (type 1 diabetes, infection)
Referral 10 Handwritten note 222
Mrs Lundquist, Room 408 (gestational diabetes)

The commentaries: the mini-cases 223

Mini-case 1 Multiple sclerosis, obesity 223
Mini-case 2 Anterior resection of bowel 223
Mini-case 3 Obesity, weight control 224
Mini-case 4 Obesity, nutritional screening 224
Mini-case 5 Coeliac disease, peer-reviewed information 225
Mini-case 6 Type 2 diabetes, dietary compliance 225
Mini-case 7 Obesity, aggressive weight loss 226
Mini-case 8 Hip replacement, nutritional status 226
Mini-case 9 Unconscious patient, feeding issues 227
Mini-case 10 Weight loss, older client 228

The appendices: clinical information and reference data 231

The appendices: tools 265

Index 275

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Dr Fred Pender BSc, PhD, RD is Director of Dietetics at University College, Chester
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* The author is an experienced therapeutic dietitian who believes strongly that a problem-driven curriculum, using the clinical case as the major learning strategy, produces the most effective practitioners


* No comparable textbook exists using clinical cases to explore concepts in practical dietary interventions


* Problem-based learning is becoming an increasingly important component of undergraduate teaching

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