What nutritional risks are related to hydration and kidney function?
Imagine that you are a clinical nutrition assistant working at a local hospital under the supervision of a Registered Dietitian (RD). Overnight, a 74-year-old male patient was admitted to the hospital and needs to be fully assessed for any nutritional risks (in accordance with hospital/medical nutrition care laws). The hospital’s initial nutritional screening protocol identified that the patient may be at nutrition risk, due to a “high risk admitting diagnosis.” The admitting physician suspects that the patient has suffered a heart attack; however the full cardiac consult results are not yet showing in the computer. Furthermore, the patient has recently moved here to the U.S. from a foreign country within the past year so that his daughter can help care for him due to his declining health. The entire family speaks very little English. The patient’s cultural background is significant because the culture may not place much influence on western-style healthcare practices. The patient’s expression of his culture needs to be examined further. The nurse’s notes reveal that the daughter does not know how much her father weighs, but she suspects that he has gained weight since her mother passed away a year ago.
Your assignment from the supervising RD is to examine the patient’s complete cultural, social, medical, and nutritional background so that the next steps of the Nutrition Care Process can be instituted. Upon your initial investigation within the hospital’s electronic medical records system, you notice that there is no height or weight listed for the patient. The diet order reads: NPO (nothing by mouth) and they are awaiting more lab results for various tests related to hydration and kidney function. His cardiac enzyme lab work indicates that he suffered a Myocardial Infarction (MI). The MD notes confirm a heart attack diagnosis and the MD also noted that the patient “appears to be morbidly obese.” His medications include: a blood pressure medication, a diuretic, and a cholesterol-lowering drug.
Imagine that you have to complete this “demographic/cultural” background patient research for your supervisor within the next couple of hours. Record and describe this fictional patient’s cultural background information by listing the answers to certain questions (translator may be requested in hospitals). Record observations, human expressions, and any other unique characteristics about the patient’s culture or background that may impact his ability to adhere to any type of medical nutrition therapy, nutrition education, or dietary restrictions. (You may use information created in the Unit 6 Discussion Board here).
The patient and daughter are unaware of the patient’s current height and weight. His hospital bed unfortunately does not have a built-in weight scale. The patient is unable to stand upright due to his medical condition. Therefore, list and describe one alternative way to estimate height (stature) and one alternative way to estimate a person’s weight that is covered in Chapter 7 of the textbook. (Refer to page 254 for general ideas and Tables 7.1, 7.3, and 7.4.)
Based on your knowledge of the patient’s cultural background as well as your evaluation and observations of your current interactions with the patient and daughter, do you believe the patient will comply with the MD suggesting a strict, very low calorie (1000–1200 calories), low fat, low cholesterol, and low salt diet, due to the heart attack/cardiac consultation results and morbidly obese appearance?
Suggested change: How will you relay your assessment of the patient’s readiness to comply with a highly restrictive diet with the supervising dietitian? How can you use your knowledge of the patient’s cultural background to instill motivation and the desire to improve his health by eating a healthy diet? Do you think the patient should be placed on the exact diet the physician is recommending?
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