1. Initial Assessment Data for Jordan

As the nurse assigned to Jordan, the initial assessment data would include a comprehensive evaluation of his physical, psychological, and social health. The following aspects should be considered:

• Physical Assessment:
  • Height and Weight: Jordan is 14 years old, weighs 275 pounds, and is 5’6” tall. This gives him a BMI of approximately 44.3, placing him in the category of severe obesity, which is a critical factor in assessing his overall health.
  • Vital Signs: Blood pressure, heart rate, respiratory rate, and temperature to establish a baseline and identify any immediate concerns.
  • Dietary Habits: A detailed assessment of Jordan’s daily food intake, eating patterns (e.g., skipping meals, binge eating), and food preferences. His statement about going days without eating and then bingeing is concerning and suggests disordered eating behaviors.
  • Physical Activity: Evaluate his level of physical activity, particularly noting his avoidance of gym class and any physical activities due to bullying.
  • Symptoms of Gallbladder Disease: Jordan has been diagnosed with gallbladder disease, and it’s important to assess the frequency, severity, and triggers of his symptoms, such as pain in the mid-epigastric region, right upper quadrant, and right subscapular area after eating.
  • Family Medical History: Jordan’s family history is significant, with his grandfather dying of a heart attack at 44, and his mother’s belief in a genetic predisposition to obesity. This information is critical for understanding his risk factors for cardiovascular disease and other related conditions.
• Psychosocial Assessment:
  • Mental Health: Assess Jordan’s emotional and psychological well-being, including signs of depression, anxiety, or low self-esteem due to bullying and social withdrawal. His avoidance of social activities and school, particularly gym class, is indicative of significant distress.
  • Bullying and Social Isolation: Explore the extent and impact of bullying on Jordan’s mental health and school attendance. Understanding the nature and frequency of bullying can guide interventions to support his social well-being.
  • Family Support: Evaluate the level of support Jordan receives from his family and their attitudes towards his weight and health. The mother’s resignation to “fat genes” may impact how Jordan views his ability to change his lifestyle.
  • Coping Mechanisms: Assess how Jordan copes with stress, particularly related to his weight, school, and social interactions. His statement about not eating for days suggests unhealthy coping strategies.

2. Education Based on RDA and Gallbladder Disease

As part of Jordan’s care plan, it is essential to provide education that addresses both his nutritional needs and the management of his gallbladder disease. The following points should be included:

• Recommended Daily Allowance (RDA) and ChooseMyPlate Guidelines:
  • Balanced Diet: Educate Jordan on the importance of a balanced diet that includes a variety of food groups: fruits, vegetables, grains, protein, and dairy, as recommended by the ChooseMyPlate guidelines. Emphasize portion control and the need to eat regular meals to avoid extreme hunger and subsequent binge eating.
  • Nutrient-Dense Foods: Encourage Jordan to choose nutrient-dense foods that provide vitamins, minerals, and other essential nutrients without excessive calories. This includes whole grains, lean proteins, fruits, and vegetables.
  • Healthy Fats: Given his gallbladder disease, Jordan should focus on consuming healthy fats in moderation, such as those from nuts, seeds, avocados, and fish, while avoiding high-fat, fried, and greasy foods that can exacerbate his symptoms.
  • Hydration: Stress the importance of drinking plenty of water throughout the day to stay hydrated and support his overall health.
• Gallbladder Disease Management:
  • Low-Fat Diet: Educate Jordan on the need to follow a low-fat diet to manage his gallbladder disease and prevent the triggering of symptoms. Foods high in fat can cause the gallbladder to contract more forcefully, leading to pain.
  • Small, Frequent Meals: Advise Jordan to eat smaller, more frequent meals instead of large meals, which can help reduce the workload on his gallbladder and minimize discomfort.
  • Avoiding Trigger Foods: Identify and avoid foods that commonly trigger gallbladder symptoms, such as fried foods, fatty cuts of meat, full-fat dairy products, and processed snacks.
  • Gradual Weight Loss: Discuss the importance of gradual weight loss rather than rapid weight loss, which can worsen gallbladder issues. A healthy rate of weight loss is typically 1-2 pounds per week.
  • Physical Activity: Encourage Jordan to gradually incorporate physical activity into his daily routine, focusing on activities he enjoys and feels comfortable with. This can help improve his physical health, mood, and self-esteem.
• Mental and Emotional Health:
  • Addressing Bullying: Provide resources and support for Jordan to cope with bullying, such as counseling services or support groups. Emphasize the importance of talking to a trusted adult or counselor about his experiences.
  • Building Self-Esteem: Encourage activities that build Jordan’s self-esteem and promote a positive body image, helping him to feel better about himself regardless of his weight.
  • Family Involvement: Engage Jordan’s family in his care plan, educating them on how to support his efforts to lead a healthier lifestyle. Address any misconceptions they may have about weight and genetics.