RD Shadow Experience Susie Lewis FN 4380 3613

RD Shadow Experience Susie Lewis FN 4380 3/6/13

Karyn Martin, MS, RD, LD �Otterbein-Senior Life Style Choices- Perrysburg, Ohio �BGSU graduate �Worked 10 years in Food Service Management �Has worked for Otterbein 17 years � 5 small houses, 1 therapy/skilled care �Beauty shop, Exercise room, Game room �Elders (residents) and Elder Assistants (staff) � 2 assistants/shift/house

Otterbein Small Houses

Case Study �BC – 29 y. o. male �Admit date 3/17/12 �Spinal cord injury �Ht 5’ 10”, 177. 8 cm �Wt. 151 #, 68. 6 kg �IBW 156# +/- 10% �%IBW = 98. 7% normal �BMI = 21. 96 normal �BP 122/76 �Baseline temp 97. 3 degrees

Diagnoses � ICI oth & uns nat w/o OPN ICW UNS SOC � Abnormal posture � Calculus of kidney � Candidiasis of mouth � Dysphagia unspec � Post traumatic seizures � UTI site not specified � Injury to unspec cranial nerve � Muscle weakness (generalized) � Contracture joint site unspecified � Personal hx traumatic brain inj � Unspecified constipation � Other acute pain � Unspecified effect reduced temperature � nausea & vomiting � Open wound of chest � Depressive disorder NEC � Disturbance of salivary secretion � Other nonspecific abnormal find lng field

Alerts Drug Allergies Alerts �Codeine �Dehydrated – output �Sulfa (sulfonamide exceeds input �Wt loss – 3# over last 30 days (154#-151#) on admission to Otterbein antibiotics)

Medications � Amanadine � Dantrolene � Hyosoyamine sulfate � Keppra � Omeprazole � Phenergan � Tretinoin � Nystatin � Nasal spray � Maalox advanced � Benzactin � Aquaphore (cream) � Sensicare (cream) � Allegra � Apple, orange, grapefruit juices absorption of drug � Albuterol sulfate � Aplisol � Miralax � Percocet � Tylenol � Water � Ativan � Grapefruit/citrus – ↑ fat absorption � Celexa � Alcohol, tryptophan supplements, SJW - ↑side effects

Nutrition & Diet History/Orders �Nectar thickened liquids �Currently NPO – thrush �Isosource 1. 5 cal (lactose-free food w/fiber) � 8 am, 12 pm, 4 pm, 8 pm, 11 pm, 4 am �Flushes 150 ml after feed �d/c 4 am bolus due to increased weight gain �Head of bed elevated 35 -40 degrees �Left ear known to rupture – put nothing in it �Elevate legs as needed d/t hypotension �Reposition elder every 2 hrs to relieve pressure �OT/PT and foot wound care

Lab Values �Labs �CBC - WNL �Albumin - as needed �Radiology - none

Estimated Energy Needs/Dietary Notes � 25 kcal/kg BW = 1715 kcal +/-10% � March 2012 – d/c Jevity 1. 5, 240 m. L q 4 hrs. Start Isosource 1. 5, 240 m. L w/water flushes 150 cc q 4 hrs. � 85% of IBW of 166# due to hospital admission � Estimated nutritional needs: � 1500 -2250 kcal/d � 75 g. Pro � 2250 cc fluid/d � Communicates by blinking, moving eyebrows, thumbs up. Mother wants weight maintained at 150#.

Goals �No S/S N/V/D/aspiration/residuals �No significant weight change in 1 month �Adequate meal consumption R/T nutritional needs AEB maintenance of weight �Skin will remain healthy and intact

Prognosis �Surgery is scheduled in 2 months. The plate covering his brain has shifted �Prognosis: Patient won’t be able to tolerate surgery

R. D. Recommendations �To physician for wound healing, liquid multivitamin �Patient has Stage 2 wound on L foot �Nutritional considerations: �Adequate calories, protein, fluids, nectar thick liquids while maintaining weight �Nutrients are being met by PN

NCP: Monitoring �Achieving optimal nutritional care �Monitor G-tube �Meal intake monitored �Medications monitored �Monitor S/S N/V/D/aspiration and residuals �Monitor weight �Supplement as ordered – None �Food preferences

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