RD Shadow Experience

Susie LewisFN 43803/6/13

RD Shadow ExperienceKaryn Martin, MS,RD,LDOtterbein-Senior Life Style Choices-Perrysburg, OhioBGSU graduateWorked 10 years in Food Service ManagementHas worked for Otterbein 17 years5 small houses, 1 therapy/skilled careBeauty shop, Exercise room, Game roomElders (residents) and Elder Assistants (staff)2 assistants/shift/house

Otterbein Small HousesCase StudyBC 29 y.o. maleAdmit date 3/17/12Spinal cord injuryHt 510, 177.8 cmWt. 151 #, 68.6 kgIBW 156# +/- 10%%IBW = 98.7% normalBMI = 21.96 normalBP 122/76Baseline temp 97.3 degrees

DiagnosesICI oth & uns nat w/o OPN ICW UNS SOCAbnormal postureCalculus of kidneyCandidiasis of mouthDysphagia unspecPost traumatic seizuresUTI site not specifiedInjury to unspec cranial nerveMuscle weakness (generalized)Contracture joint site unspecifiedPersonal hx traumatic brain injUnspecified constipation

Other acute painUnspecified effect reduced temperaturenausea & vomitingOpen wound of chestDepressive disorder NECDisturbance of salivary secretionOther nonspecific abnormal find lng fieldAlertsDrug AllergiesAlertsCodeineSulfa (sulfonamide antibiotics)Dehydrated output exceeds inputWt loss 3# over last 30 days (154#-151#) on admission to OtterbeinMedicationsAmanadineDantroleneHyosoyamine sulfateKeppraOmeprazolePhenerganTretinoinNystatinNasal sprayMaalox advancedBenzactinAquaphore (cream)Sensicare (cream)

AllegraApple,orange,grapefruit juices - absorption of drugAlbuterol sulfateAplisolMiralaxPercocetTylenolWaterAtivanGrapefruit/citrus fat absorptionCelexaAlcohol, tryptophan supplements, SJW - side effects

Nutrition & Diet History/OrdersNectar thickened liquidsCurrently NPO thrushIsosource 1.5 cal (lactose-free food w/fiber)8am, 12pm, 4pm, 8pm,11pm, 4amFlushes 150ml after feedd/c 4am bolus due to increased weight gainHead of bed elevated 35-40 degreesLeft ear known to rupture put nothing in itElevate legs as needed d/t hypotensionReposition elder every 2 hrs to relieve pressureOT/PT and foot wound care

Lab ValuesLabs CBC - WNLAlbumin - as neededRadiology - none

Estimated Energy Needs/Dietary Notes25 kcal/kg BW = 1715 kcal +/-10%March 2012 d/c Jevity 1.5, 240mL q 4 hrs. Start Isosource 1.5, 240 mL w/water flushes 150cc q 4 hrs. 85% of IBW of 166# due to hospital admissionEstimated nutritional needs:1500-2250 kcal/d75 g. Pro2250 cc fluid/dCommunicates by blinking, moving eyebrows, thumbs up. Mother wants weight maintained at 150#.

GoalsNo S/S N/V/D/aspiration/residualsNo significant weight change in 1 monthAdequate meal consumption R/T nutritional needs AEB maintenance of weightSkin will remain healthy and intact

PrognosisSurgery is scheduled in 2 months. The plate covering his brain has shiftedPrognosis: Patient wont be able to tolerate surgery

R.D. RecommendationsTo physician for wound healing, liquid multivitamin Patient has Stage 2 wound on L footNutritional considerations: Adequate calories, protein, fluids, nectar thick liquids while maintaining weightNutrients are being met by PNNCP: Monitoring Achieving optimal nutritional careMonitor G-tubeMeal intake monitoredMedications monitoredMonitor S/S N/V/D/aspiration and residualsMonitor weightSupplement as ordered NoneFood preferences

Role of the R.D.Maintain patients weight at 150 lbs Adjustments continually made by adding/removing 1 bolus RD orders all diets and changes. M.D. oks laterRD requests multivitamin supplements as needed for additional healing (Wound healing of L foot).