For information and reference only – not to be submitted as your own work. This is a model answer to show structure and depth. Your institution’s academic integrity rules apply to anything you submit.

This page shows what a strong answer to the MNU33006 Nutrition and Wellness case study brief can look like. The brief is only 500 words, so the model answer below is also about 500 words, written from an intellectual disability nursing perspective. For the full explanation of how to plan it, read our guide on how to write a nutrition case study.

Model answer (about 500 words)

The client is fictional and pseudonymised. Figures are illustrative so the method is visible.

Client and diet

Maeve (pseudonym) is a 34-year-old woman with a moderate intellectual disability and cerebral palsy, living in a five-person community house. Following speech and language therapy (SLT) assessment she receives a minced and moist diet (IDDSI Level 5) with mildly thick fluids (Level 2). Staff report porridge at breakfast, a blended sandwich filling at lunch, a cooked dinner and two snacks. She often leaves a third of each meal, tires part-way through and coughs on thin fluids. Fruit and vegetables are rare because fibrous textures are avoided. Her intake falls when mealtimes are rushed.

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Key issue: dysphagia-related malnutrition risk

Dysphagia is more common in people with more severe intellectual disability, cerebral palsy and motor impairment (Robertson et al., 2017), so Maeve’s risk was predictable. I would begin with the Malnutrition Universal Screening Tool (MUST) (Todorovic et al., 2011). Her height is 1.62 m and weight 50.4 kg, giving a BMI of 19.2 (score 1). Four months ago she weighed 53.6 kg, a 6% unplanned loss (score 1). There is no acute illness (score 0). The total is 2, indicating high risk.

Screening is not assessment, so I would add the ABCD framework. Anthropometric: monthly weights, and mid-upper arm circumference if weighing becomes unsafe. Biochemical: bloods requested through her GP, such as full blood count, ferritin and vitamin D. Clinical: coughing, chest infections, dentition, constipation and medication effects on appetite. Constipation, common in this group, can further suppress appetite, so bowel records are included. Dietary: a three-day food record and direct observation of a mealtime. Because Maeve cannot report hunger, observation matters more than self-report. HSE (2020) names MUST and MUST-ID and accepts there is no single best tool, so I would note that MUST may not capture every need and use clinical judgement.

The nurse’s role

First, I would refer Maeve to the dietitian, as HSE (2020) requires for residents at risk of malnutrition, and request SLT review, because texture changes must be identified by the SLT, not by staff. Second, I would fortify what she can safely eat: full-fat milk, butter and cream in porridge and sauces, with small, frequent meals. Supplements would be used only if prescribed.

Third, mealtimes: unhurried, upright, in her preferred seat, with a dysphagia-trained staff member beside her. I would update her communication passport so she can signal “finished” or “more” and use pictures to offer choice, protecting her participation in decisions about food. I would also teach staff to recognise early signs of aspiration, such as a wet voice, coughing and repeated chest infections, and to report them the same day. Fourth, I would write these actions into her care plan, brief the team, rescreen with MUST in line with her risk category, and escalate to the GP if weight falls further. The goal is stable or rising weight within three months and no aspiration-related chest infection, reviewed with Maeve, her family and the multidisciplinary team.

How this model answer maps to the marks

Annotated commentary

• One issue, not four. Obesity and constipation are real concerns in this population, but the answer stays with dysphagia and malnutrition risk.
• The MUST arithmetic is shown, so the marker can see it is applied rather than named. BMI 18.5 to 20 scores 1 and weight loss of 5 to 10% scores 1 on the BAPEN scheme (Todorovic et al., 2011).
• Scope is respected: the nurse refers for texture and dietetic input rather than prescribing them.
• Each of the three references earns its place. Weaker answers spend the allowance on general textbooks.

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About the expert

Dr. Eimear O’Dwyer has over 14 years of experience helping nursing students. Her profile describes work on nursing and healthcare assignments that pair current research with clinical practice.

References

• Health Service Executive. (2020). Food, nutrition and hydration policy for adults accessing disability services (Version 1). https://assets.hse.ie/media/documents/ncr/food-nutrition-and-hydration-policy-for-adults-accessing-disability-services1.pdf
• Robertson, J., Chadwick, D., Baines, S., Emerson, E., & Hatton, C. (2017). Prevalence of dysphagia in people with intellectual disability: A systematic review. Intellectual and Developmental Disabilities, 55(6), 377–391. https://doi.org/10.1352/1934-9556-55.6.377
• Todorovic, V., Russell, C., & Elia, M. (Eds.). (2011). The ‘MUST’ explanatory booklet: A guide to the ‘Malnutrition Universal Screening Tool’ (‘MUST’) for adults (Rev. ed.). BAPEN. https://www.bapen.org.uk/pdfs/must/must_explan.pdf