CASE STUDY: James has been gaining weight over the last five years in his group home

and his
doctor has said that he needs to exercise more or he will become obese. James is 62, a large man
weighing around 200 pounds, who really doesn’t want to be told that he needs to exercise for his
health.

When James first came to the group home he was much more active than currently. He would go
for walks in Sunrise Park by himself when the weather was good and he seemed to enjoy that.
He also bowled every week with the other men in the group home and was very good at it. A
year later James climbed Mt. Clemons with one of the staffs. Unfortunately, the staff person left
his job at the group home about three months later and no one else was interested in taking him
hiking. He worked out at the YMCA for a period of time but he didn’t find other people to work
out with him and he quit. James started eating more food within the next year as he started to
gain weight.

ADIME Format of Documentation

 Determine the patient's purpose for losing weight, Is it for

his physical appearance or health reason.
 Assess client’s behavioral variables lead to overeating.
Assessment  Take note of the weight and height of the client as well as
his waist measurement, and calculate the BMI (BMI)
 Acquire detailed history to the patient.

 Imbalanced Nutrition: More Than Body Requirements r/t

calorie intake exceeding metabolic needs
 Impaired Physical Mobility r/t restricted movements
secondary to excess weight
 Disturbed Body Image r/t to excess weight
Diagnosis  Deficient Knowledge r/t lack of interest in losing weight;
decreased motivation to lose weight

 Carry out and review daily food diary of the patient that
includes (caloric intake, types and amounts of food, eating
habits).
 Formulate an eating plan with the patient, using knowledge
of individual’s height, body build, age, gender, and
individual patterns of eating, energy, and nutrient
requirements. Determine which diets and strategies have
Intervention been used, results, individual frustrations and factors
interfering with success.
 Discuss need to give self-permission to include desired or
craved food items in dietary plan.
  Identify realistic increment goals for weekly weight loss.
 Develop an appetite reeducation plan with patient.

 The patient will have balanced nutrition where calorie

intake meets metabolic needs leading to weight loss.
 The patient will demonstrate increased physical mobility as
Monitoring evidenced by increased daily activities and reduced body
and fat.
Evaluation  James will exhibit an improved body image as evidenced
by consistent self-care and successful weight loss efforts.
 The patient will verbalize a desire to learn new strategies to
lose weight.