Nutritional and Clinic Status

Imagine that you are working in a hospital setting as a nutrition educator under the supervision of a Registered Dietitian (RD). On this particular day the supervising dietitian gives you a referral for a new patient that has been admitted into the cardiac care unit. Your task is to be able to summarize the Mr. Es nutritional and clinical status to the supervising dietitian. You will also need to design a realistic meal plan for Mr. E.

Mr. E is a 55 year-old corporate lawyer who was last seen a year ago for a physical examination. At that time he appeared to be in relatively good health. Reported weight is 200 pounds and his height is 5 10. His blood pressure was 140/85 and total cholesterol was 225 mg/dl. The medical history reveals a history of GERD and occasional constipation. The medication list in his chart does not show any daily prescriptions for the GERD diagnosis. He has no hobbies or outside activities except occasional golf with his friends. His workdays are sometimes long and hectic. During the last check up the doctor advised him to get a daily exercise program and lose 20 lbs. Upon further reading within the referring physicians medical note you see that Mrs. E reports that her husband often chews antacid tablets like candy and that he suffers from bouts of constipation that sometimes require the usage of laxatives or enemas that she purchases for him when he becomes desperate.

From the hospital admission records you were able to gather that three months have passed and that Mr. E collapsed during a meeting at work after a sudden onset of severe chest pain that radiated into his left arm. He was brought to the emergency room pale, frightened, and short of breath. He was cold, sweaty, and vomited shortly after arriving in the emergency room. His nail beds and lips were cyanotic (bluish tint)  and blood pressure was 100/70.

Mr. E was placed on strict bed rest and a clear liquid diet was ordered after day one and then he was progressed to a full for 2 days. The attending Cardiologist has a standard protocol to progress patients like Mr. E to a low saturated fat, 1200 kcal soft diet the fourth day. You, as the nutrition educator, visited him and reported that his appetite was improving and responding well to the treatment. A regular texture diet was then recommended after you reported your findings to the supervising RD. The MD ordered a 1600 kcal(1600 calories), low-saturated fat, low-cholesterol diet by the end of the week and this diet order was written on the discharge paperwork. The diet specifications were for cholesterol limited to no more than 300 mg. Daily and total fat was limited to 20% of total kilocalories (kcals=same as calories), with not more than 7% of total calories coming from saturated fats.

Just before discharge, you and the RD met with Mr. E and his wife several times to discuss his home care and dietary regimen. You noticed that the MD did not address the previous GERD and occasional constipation reports. The RD asked you to contact the attending physicians office to get verbal approval for appropriate diet therapy discharge orders that address his heart health, GERD, and constipation. Mr. E showed good general recovery and was willing to continue his new modified food plan, but admitted that his wife would need to be the main source of support and meal preparation.

    1-What is meant by the term “myocardial infarction” and how does it apply to this scenario?
    2-What were the predisposing factors in Mr. Es lifestyle that placed him in the high risk category?
    3-What were the reasons for modification and progression from liquids to solids and the changes in texture, fats, and total caloric level in each diet prescribed for Mr. E? In other words- why do hospitals often slowly re-start oral intake after a heart attacking, stroke or many surgeries? What are some considerations when advancing the diet from liquids to soft -or regular solids? Has the  Doctor  considered the long term implications of this patient remaining on this diet order  after discharge  ? 
    4-Explain why it was imperative that you, as the nutrition educator, address his other medical issues when planning the diet that the Cardiologist originally ordered for hearth health promotion.
    5-What other advice could you give Mrs. E regarding preparation and shopping for recommended foods on the diet? Be sure to include all aspects of his dietary needs related to the heart healthy aspects as well as the GERD and occasional constipation that requires laxatives/enemas on occasion. If you had time with Mr. E and his wife, what other questions would like to ask about his previous dietary practices and why?
    6-Appendix-Write a sample menu for Mr. E to follow when he arrives home. Show the calorie, total fat, cholesterol, saturated fat, and fiber content and how the food choices meet the guidelines prescribed. (should be UNIQUE- although you can look up a sample diet + make appropriate substitutions to make it unique)
    Requirements: Paper format: Answer questions numbers 15 in a 23 page paper in APA format. Include a title page, introduction, body, conclusion, and reference page. Answer question number 6 as an appendix. Be aware that the title page, reference page, and appendix (menu)  DO NOT count towards the 23 page minimum.

Please organize your paper in the following paragraph format. Please see Purdue Univ Global’s Writing Center for more information regarding essay and paragraph format.ESSAY PORTION: 2-3 pages. The answers to the assigned questions should reach 2-3 pages (it is OK to go over this length) . Title, reference, or appendix pages DO NOT count towards the essay length min. The essay portion should be in APA format (12 pt, traditional type font-Arial/times new roman, double spaced-not manual but automatically formatted from word paragraph formatted). Please DO NOT re-type the assigned questions or the case study information into the paper. You should form your own topic sentences for each of the below paragraphs. Please write formally and professionally. Refrain from using personal pronouns such as I and me in formal papers. You can say things like in order to understand the complexities of heart disease treatment; one must examine the risk factors and available nutrition and medical therapies.  OR  “research has found that a diet high in fiber can aid in xxxxx….”(resource author, year).  It is recommended for heart disease patients to consume xxxxx  (author, year).  (phrases like : it is recommended or  research has found  are great ways to avoid using the personal pronoun “I”)

Section 1= Answer ?#1 here-Introduction paragraph. This should include a thesis statement (see writing center LINK above re: topic /thesis statements) that covers what will be discussed in the paper. It is best to avoid phrases like This essay will cover or I will discuss. Please answer the assigned question #1 in this paragraph along with a brief introduction to the patient/major topics. What is meant by the term myocardial infarction?

2= Sub topic paragraph 1: answer ? 2 here.What were the predisposing factors in Mr. Edwards lifestyle that placed him in the high risk category? Please use references to the textbook and or other reputable sources to support your answer. Why xxxx symptom/lab value etc is a risk factor for cardiac disease?

3= sub topic paragraph 2: What were the reasons for modification in texture, fats, and total caloric level in each diet prescribed for Mr. Edwards?  Think about what he has been through + what the MD may be concerned about.  (ex- if stroke risk- then swallowing function is ALWAYS a concern….CVA-Stroke pts  can be at increased risk for aspiration. (choking) Another consideration is to confirm GI function + establish GI tolerance…..what do this mean? other reasons for modifications can be explored…

4=Sub topic paragraph 3: Explain why Mr. Edwards final diet order is appropriate for his lipid disorder.  Use quotes- paraphrases here from the Purdue Global Library!  Here is a LINK to help you search the journal article Databases for research published on the link b/w dietary inake + cholesterol -lipid levels.

5th= Conclusion paragraph- summarize recs + justify reasoning for dietary recommendations.What other advice could you give Mrs. Edwards regarding preparation and shopping for recommended foods on the diet? Also, provide a good summary of what was covered in the essay & any future implications.

Appendix: Your response to question 6. One days worth of meals/snacks should be included in an organized table/chart. Please include the serving sizes of all the foods/beverages. There should be a daily totals column provided for the nutrients: calories, total fat, cholesterol, and saturated fat. Other nutrients that can be included that may be beneficial would be sodium, fiber, and water/fluid recommendations.  (hint-remember the heart issues + GERD diagnosis when planning the diet).        Write an ORIGINAL sample menu for Mr. E to follow when he arrives home. Show the calorie, total fat, cholesterol, and saturated fat content and how the food choices meet the guidelines prescribed. One days worth of meals/snacks should be included in an organized table/chart. Please include the serving sizes of all the foods/beverages. There should be a total column provided for the nutrients outlined above- please show how this meets the heart healthy guidelines. It is OKAY to use different amounts or rec diff calories. SCREENSHOTS from nutrient analysis programs can be used instead of making-typing new tables.  Just make sure to include the food items-serving sizes + the TOTALS for the day for Calories + fat grams + other important nutrient totals.

References: Incorporate a minimum of three quality references. Your textbook may count towards this requirement. You can use reputable websites or other textbooks/ scientific or medical journal articles. Please use APA style citations within the paper itself and also on the reference page.

 

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