Transcript File - Susan Lynn Lewis

RD Shadow Experience
Susie Lewis
FN 4380
3/6/13
Karyn Martin, MS,RD,LD
 Otterbein-Senior Life Style Choices
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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
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
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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
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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
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Nectar thickened liquids
Currently NPO – thrush
Isosource 1.5 cal (lactose-free food w/fiber)
8am, 12pm, 4pm, 8pm,11pm, 4am
Flushes 150ml after feed
d/c 4am 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, 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 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).