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RD Shadow Experience

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

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RD Shadow Experience

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

  2. 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

  3. Otterbein Small Houses

  4. 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

  5. Diagnoses • ICI oth & unsnat w/o OPN ICW UNS SOC • Abnormal posture • Calculus of kidney • Candidiasis of mouth • Dysphagiaunspec • 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

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

  7. 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

  8. Nutrition & Diet History/Orders • 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

  9. Lab Values • Labs • CBC - WNL • Albumin - as needed • Radiology - none

  10. 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#.

  11. 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

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

  13. 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

  14. 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

  15. 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).

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