When Neuropathy Impact’s Your Patient’s Ability to Prepare Meals
In this blog post you’ll learn how nerve damage such as diabetic neuropathy can impact your patient’s ability to perform simple tasks in the kitchen like opening a jar or chopping vegetables. You’ll also learn about adaptive kitchen tools can help patients maintain autonomy and independence in the kitchen.
THE SCENARIO
the nutrition consult:
Your a dietetic intern completing your clinical rotation and get a consult for nutrition education. You complete the chart review find out that the patient has a history of Type 2 diabetes. You think this will be a straight forward education. They appear to be eating fine per the documented meals, they’re on a carb controlled diet, there’s no recent weight change documented, skin is in tact and labs appear within normal range. You do notice the patient has elevated blood glucose levels and elevated A1c which could likely be related to their history of diabetes.
your initial intervention plan (before seeing the patient):
Upon completing the chart review, you make an educated guess about the nutrition related problem and how you can help.
Problem: Altered nutrition-related labs
Etiology: related to uncontrolled diabetes
Signs / Symptoms: as a sign of elevated A1C level of 9.5%
You print out some handouts on foods that contain carbohydrates, as well as a list of protein containing foods and a list of foods high in fiber. You plan on reviewing the basics of carbohydrates and how they impact blood sugar, and how protein and fiber can help control blood sugar levels.
the nutrition counseling session:
When you go see the patient and find out that they have been dealing with diabetic neuropathy and haven’t been able to prepare the same meals like they’ve done before and have seen an increase in their blood sugar.
They enjoy cooking but it has been increasingly difficulty with the pain in their hands and feet. It was mild for the last few years, now it’s gotten worse. They can’t stand too long, they can’t cut vegetables, and even find it challenging to use their can opener. So they’ve been ordering out more and purchasing frozen meals. They also mention that they even have difficulty gripping the plastic wrap on the frozen meals at times.
You also learn that your patient lives alone and every Sunday she has her family over for a big family meal which she looks forward to every week. However, she mentioned that lately she hasn’t been looking forward to these family meals because she can’t help out with the cooking as much and feels like a burden since everyone else is cooking.
Your patient states that she would like to get back to cooking more and get her blood sugars back to where they were.
Peripheral Neuropathy
Patient’s with peripheral neuropathy will experience weakness, numbness tingling, and pain in either their hands and/or feet. (1, 2) Patient’s can also report clumsiness and often lose their balance. These symptoms of peripheral neuropathy can limit a patient’s ability to perform basic kitchen tasks such as holding a knife, chopping vegetables, picking up a spoon, standing too long, etc. In addition, making it dangerous for the patient.
Your New Plan (after seeing the patient)
Now that you have a better understanding of the patient and the challenges they are experiencing as they try to manage their blood sugar control you decide to change your original intervention to better assist the patient’s concerns.
Revised PES Statment:
Problem: Impaired ability to prepare foods / meals
Etiology: related to peripheral neuropathy
Signs / Symptoms: as a sign of patient reported experiencing pain holding knife and standing too long, and A1C Levels increased from 6.8 to 9.5 in a period of six months.
Revised Intervention:
review basics of carbohydrate sources, protein sources, and fiber sources
discussed options to swap alternatives. Instead of cutting whole fruits and vegetables use frozen, canned or bagged fresh precut alternatives if available or affordable
adaptive kitchen equipment that can aid with food preparation
automated soap dispenser
adaptive cutting board
electric can opener
jar opener
cut resistant gloves
rocking T knife
grip utensils
Download the Nutrition Assessment Bonus Bundle for more examples of PES Statements.
