Supplements
15 years ago
Saturday, March 29, 2008
Monday, March 24, 2008
Imbalanced nutrition
Dementia
Hypothyrodizm
Confusion
Depression
Dry oral mucosa
Requires assistance with feeding
OOB to the chair
Appears malnourished, able to feel bones through the skin
Poor appetite
Doesn’t like food served for breakfast and lunch
Nutrition imbalance less than body requirements r/t altered mental status secondary to dementia
For a diagnosis of dementia to be made, at least two domains of function must be altered—memory and at least one of the following: language, perception, visuospatial function, calculation, judgment, abstraction, and problem-solving. Because of inability to hake choices, person might have difficulty eating foods that are needed. Memory impairment can also affect nutrition, people with impaired memory might forget to eat and drink. (Brunner, 243)
According to Carpenito, Imbalance nutrition less than body requirements is the state in which an individual, who is not NPO, experiences or is at risk for inadequate intake or metabolism of nutrients for metabolic needs with or without weight loss.
Mrs. JG has dementia. She is confused and unable to make healthy choices. She doesn’t ask for food and has to be reminded to eat and drink.
Pt. will consume at least 25% of meal WIMC.
1.Assess v/s
2. Assess nutrition status
2a.Assess weight.
2b. record I&O
3.Place pt. on calorie count
4.Perform oral hygiene
5a.Provide pt. with proteins
5b. Provide pt. with carbohydrates (sugar, fiber, and starch.)
5c. Provide pt. with fats
6.Offer pt. small meals
7. Provide pt. with food preferences.
8. Provide pt. with appropriate environment.
9. Administer Seroquel
Assess for therapeutic and side effects. Teach about therapeutic and side effects of Seroquel
10a. Assess pts. mental status
10b. Assess pts. developmental level
10c.Assesses pts. orientation and level of consciousness
10d.Assess pts. level of anxiety
10e. 17.Teach pt. about nutrition
11. Administer Zithromax. Assess for therapeutic and side effects.
12. Provide pt. with supplement
Ensure PO TID
13.Refer pt. to dietician
14. Assist patient with feeding, open the containers.
14.Obtain Pts. labs
a.HGB
14b.albumin
14c. transferrion
14e. calcium.
14f. sodium
14g.potassium
1. A change in vital signs may indicate fluid, electrolyte, and acid – base imbalances. Tachycardia is a sign of hypovolemia. Irregular pulse may occur from electrolyte imbalances. An elevated temperature may be a result of dehydration or a cause of body fluid loses. Changes in the respiratory rate and depth may cause acid- base balances. Blood pressure may fall with FVD, hypovolemia, or increase with FVE. When a person’s temperature is elevated, hypermeatabolism occurs, and the respiratory rate, heart rate, and basal metabolic rate all increase.
(Kozier pg 1447, Brunner pg 101)
2. A nutritional assessment will identify clients at risk for malnutrition and those with poor nutritional status.
( Kozier pg 1252)
2a. Daily weight is an accurate measurement of pts. fluid status. Significant changes in weight over a short period of time are indicative of fluid changes.
(Kozier pg 1446)
2b. The measurement and recording of all fluid intake and output during a 24hr. period provides important data about the client’s fluid and electrolyte balance.
(Kozier pg 1447)
3. The body obtains energy in the form of calories from carbohydrates, protein, fats, and alcohol. When using a tool to measure intake it allows judgment of overall adequacy and when specific foods or nutrients are suspected of being deficient or excessive.
(Kozier pg 1237 and 1257)
4. Oral hygiene improves the pts. appetite, and improves pts. ability to taste.
( Kozier pg. 1263)
5a. Proteins in the diet provide amino acids necessary for growth and repair of animal tissue.
(Kozier pg 1233)
5b. Carbohydrates are a basic source of energy. Sugars are the simplest of all carbohydrates, are water soluble and are produced by both plants and animals.
Starches are insoluble non sweet form of carbohydrates. Fiber is a complex carbohydrate derived from plants, supplies roughage, or bulk to the diet.
(kozier pg 1232)
5c. Fats are a form of potential or stored energy. Fats are also protein spearers. And provide insulation for heat loss. Fat is needed for absorption of sat soluble proteins
(Kozier pg 1233)
6. Smaller meals help improves pt. appetite and does not discourage pt. from eating.
(kozier pg 1263)
7. Offering a pt. their food preference will improve pts. appetite with the pt. being familiar to food.(Kozier pg 1263)
8. A tidy clean environment that is free of unpleasant sights and odors will improve appetite.
(kozier pg 1263)
9. Treating schizophrenia or bipolar disorder. It may also be used for other conditions as determined by the doctor.
Seroquel is an atypical antipsychotic. Exactly how it works is not known. It affects certain receptors in the brain. This may help to improve symptoms associated with schizophrenia and bipolar disorder. Severe allergic reactions: (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); confusion; fainting; fast, slow, or irregular heartbeat; fever; increased saliva production or drooling; increased sweating; memory loss; menstrual changes; muscle pain, weakness, or stiffness; new or worsening mental or mood changes (eg, depression, hallucination); numbness or tingling; persistent, painful erection; seizures; severe or prolonged dizziness or headache; shortness of breath; swelling of the hands, legs, or feet; symptoms of high blood sugar (eg, increased thirst, hunger, or urination; unusual weakness); tremor; trouble concentrating, speaking, or swallowing; trouble sitting still; trouble walking or standing; uncontrolled muscle movements (eg, arm or leg movements, twitching of the face or tongue, jerking, or twisting); vision changes.
(#10)
10a. It reveals the clients general cerebral function. The functions it includes are intellectual and emotional.
(Kozier pg 642)
10b.According to Erickson the developmental task at this time is ego VS. despair. People who obtain ego integrity view life with a sense of wholeness and derive satisfaction from past accomplishments. They view death as an acceptable completion of life. People who experiences despair often believe they have made poor choices during life and wish they could live life over.
(Kozier 416 and 417)
10c Establishing pts. orientation determines if the pt. has the ability to recognize other persons, awareness of when and where they presently are, and who they are themselves.
level of consciousness can lie anywhere a long a continuum from a state of alertness to a coma. A fully alert pt. responds to questions spontaneously and a pt. comatose may not respond to verbal stimuli.(Kozier pg 643)
10d.A person with mild anxiety can learn to alter lifestyle habits, more severe anxiety can be paralyzing. Pts. experiencing anxiety may be worried and therefore unable to focus on complete essential self care activities.
(Brunner pg 116)
10e. Adequate nutrition provides the body with nutrients. Nutrients have three major functions: providing energy for body processes and movements, providing structural material for body tissues, and regulating body processes.(Kozier pg 1232)
11. Treating infections caused by certain bacteria.
Zithromax is a macrolide antibiotic. It slows the growth of, or sometimes kills, sensitive bacteria by reducing the production of important proteins needed by the bacteria to survive. Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bloody stools; chest pain; dark red raised areas of the skin; hearing loss; pounding in the chest; ringing in the ears; severe diarrhea; stomach cramps/pain; yellowing of the skin or eyes. (#12)
12. Nutritional supplements are often given to pts. Who are malnourished or have poor eating habits. They are high in protein and potassium.(kozier pg 1455)
13. A dietitian has special knowledge about diets to maintain health. A dietitian may design special diets to meet individual needs of pts.(Kozier pg 106)
14. Some clients are unable to open lids of containers of even to hold a spoon. They require assistance. (kozier, 1236)
14a. Low hemoglobin may be evidence of iron deficiency anemia.(Kozier pg 1258)
14b. A low serum albumin level is a useful indicator of prolonged protein depletion.
(Kozier pg 1259)
14c. Transferrin responds more quickly to protein depletion than albumin. Transferrion levels below normal indicate protein loss, iron deficiciency, hepatitis, and liver dysfunction.
(kozier pg 1259)
14e. A depletion of calcium can cause tetany with muscle spasms and paresthesias and can lead to convulsions.( Kozier pg 1441)
14f. Regulates water balance and assist in nerve impulses and muscular contractions.
(Kozier pg 1438)
14g. It is vital to normal neuromuscular and cardiac function.
(Kozier pg 1438)
1.I assessed VS to be
BP – 125/62
HR – 78 regular bounding
RR 22, regular deep, not labored
T 97.8
2. I assessed nutritional status (results below)
2a. Wt – 98lb
Ht – 5’2
2b. Intake – 60 oz of water while in my care.
Output – unable to determine due to incontinence. I&O wasn’t preformed by staff
3. Calorie count was performed daily, according to record pt was ingesting about 1500.
4. I performed oral hygiene before I tried to feed the patient.
5a. patient was provided with ensure pudding and pureed cheeseburger. She ate cheeseburger, but refused to eat ensure
5b. patient was provided with mashed potatoes, orange juice and apple sauce for lunch. She had apple juice left from breakfast. She ate mashed potatoes and asked to put a straw in her juice, but didn’t drink it when I was there. She refused to eat apple sauce, ate one spoon and said it doesn’t taste right. I brought fresh apple sauce but she refused to eat it she also had pureed vegetables, but only ate one spoon, she might have eaten more after I left, but she didn’t seem to like them.
5c. pt’s lunch had a lot of butter, meat, mashed potatoes and vegetables all had butter on them
6. I provided the patient with small frequent meals. I gave Mrs. JG ensure and apple sauce, which she refused. I removed some items from the tray and put it away for later.
7. I was unable to provide the pt. with food preferences, but to her confusion. She tried to explain to me what she wanted, but was unable to express her thoughts. I asked her about foods that were served and removed from the tray foods she said she didn’t want.
8. I provided am care and checked whether or not patient was incontinent before meal was served. Bed pans were not in sight and no foul odors were present. Patient was sitting in the chair during lunch instead of sitting in bed
9. Primary nurse administered Seroquel. Unable to determine effectiveness due to lack of time and information about condition prior to medication administration.
Patient didn’t have signs of side effects. Pt. was oriented to time only, was confused. Therefore teaching couldn’t take place.
10. I assessed mental status. Patient had dementia and depression. She expresses desire to die
10b. I assessed developmental level to be older adult and negative resolution of integrity vs. despair task. She appears hopeless and stated that the only thing she can do is to die.
10cPatient is alert and oriented to time only
10d Patient is anxious about “bumps” she found on her body and about inability to express her thoughts (moderate anxiety)
10e. Unable to teach due to patient’s lack of ability to retain information.
11. Zithromax was administered by primary nurse. No signs of allergic reaction are present. Unable to determine effectiveness due to lack of lab data. However I would’ve obtained C&S studies and WBC count to determine effectiveness of this medication. Teaching was not initiated due to patient’s inability to learn new information
12.Patient was provided with Ensure pudding TID, however she didn’t like the taste and refused to eat it
13. Pt. had a dietary consult which determined dysphasia and FTT
14. I opened containers and placed them closed to the patient, pt. was able to hold the spoon and feed herself.
14. Was unable to access results of lab work due to patient’s discharge, however I expect to find RBC and HGB to be low (patient has anemia).
No signs of calcium imbalance was present, therefore I expect Ca to be within a normal range.
Patient was dehydrated which could be a sign of Na imbalance.
I would pay careful attention to potassium level since patient is presenting some signs of potassium depletion (generalized weakness) potassium imbalance can also be very dangerous due to it’s effect on the heart muscle.
Albumin and transferrin should be within a normal range if the pt. was consuming as much protein as she was while in my care. Transferin levels could be outside of normal range due to possible iron deficiency which could be a result of anemia.
Goal not met. I encouraged pt. to eat. I explained the importance of eating however, pt. refused. Pts. appetite remains poor.
1.Pt’s vital signs present no change in nutritional status
2. Patient is underweight and isn’t consuming enough fluid. Fluid is needed to digest food, therefore it is important to increase fluid intake
3. Patient isn’t ingesting enough calories, and has to be encouraged to ingest more.
4. Pt. refused to eat ensure pudding and apple sauce after oral care, stated it didn’t taste right, however ate lunch.
5a.Patient had proteins needed. I didn’t see how much of the meat served she ate, but she seemed to eat meat before any other part of her lunch. I am unaware what she had for breakfast and dinner, but it the pt had as much protein intake during those meals as she had for lunch, she had digested daily protein requirements even though she didn’t have ensure.
5b. patient had some carbohydrates, however should eat more. Carbohydrate intake can be increased by providing juices, however it is harder to increase intake of complex carbohydrates. Fiber supplement has to be considered.
5c. pt. consumed enough fat to absorb vitamins. She shouldn’t eat too much fat to prevent complications of HTN, such as deep vein thrombosis. However she should eat enough lipids to increase weight and prevent heat loss.
6. Patient agreed to try to eat ensure and apple sauce, but after trying them, refused it. When lunch was served, she stated she cannot eat so much, but was more willing to eat after some items were removed from the tray. Unfortunately I can not be sure items I removed from the tray were later given to patient, but even if they weren’t, removing them helped to increase intake since patient wasn’t as overwhelmed be the amount of food she was seeing. It also helped to eliminated least need foods, such as simple carbohydrates.
7. Pointing out foods and asking the pt. whether or not she liked it worked much better then asking her what she liked. She became very aggravated when she was unable to explain what she wanted, but was calm when I was asking her which foods from the tray she wanted to eat.
8. Patient seemed to eat well and seemed comfortable.
9. Patient is confused, but able to follow the commands and make decisions. Although Seroquel proved to be effective in treating depression, Mrs. JG appears to be depressed and hopeless.
10a.Due to dementia, patient I unable to learn. Patient is confused and therefore cannot retain information provided
10b. Pt. can not be taught due to lack of desire to return to maximum level of activity.
10c. patient can not be taught due to confusion
10d. patient is too anxious to learn
10e. If the teaching would’ve taken place, I would have determined effectiveness of learning by asking questions about nutrition and in long term observed for healthy food choices according to content taught.
11. Not enough time was given to determine effectiveness of Zithromax in decreasing caloric requirements, however, over time I would expect weight gain.
12. Different flavors have to be offered to determine preferences and encourage pt. to eat.
13. Pureed diet was ordered for the pt.
14. Pt. was able to eat and started to ask me to open certain containers and to put a straw in juice. It appeared she had difficulties holding the spoon, but I didn’t try feeding in order to promote ability to care for self.
14. This lab values would be helpful in determining possible supplements patient might need as well as effectiveness of treatment and other factors that could contribute to malnutrition.
Dementia
Hypothyrodizm
Confusion
Depression
Dry oral mucosa
Requires assistance with feeding
OOB to the chair
Appears malnourished, able to feel bones through the skin
Poor appetite
Doesn’t like food served for breakfast and lunch
Nutrition imbalance less than body requirements r/t altered mental status secondary to dementia
For a diagnosis of dementia to be made, at least two domains of function must be altered—memory and at least one of the following: language, perception, visuospatial function, calculation, judgment, abstraction, and problem-solving. Because of inability to hake choices, person might have difficulty eating foods that are needed. Memory impairment can also affect nutrition, people with impaired memory might forget to eat and drink. (Brunner, 243)
According to Carpenito, Imbalance nutrition less than body requirements is the state in which an individual, who is not NPO, experiences or is at risk for inadequate intake or metabolism of nutrients for metabolic needs with or without weight loss.
Mrs. JG has dementia. She is confused and unable to make healthy choices. She doesn’t ask for food and has to be reminded to eat and drink.
Pt. will consume at least 25% of meal WIMC.
1.Assess v/s
2. Assess nutrition status
2a.Assess weight.
2b. record I&O
3.Place pt. on calorie count
4.Perform oral hygiene
5a.Provide pt. with proteins
5b. Provide pt. with carbohydrates (sugar, fiber, and starch.)
5c. Provide pt. with fats
6.Offer pt. small meals
7. Provide pt. with food preferences.
8. Provide pt. with appropriate environment.
9. Administer Seroquel
Assess for therapeutic and side effects. Teach about therapeutic and side effects of Seroquel
10a. Assess pts. mental status
10b. Assess pts. developmental level
10c.Assesses pts. orientation and level of consciousness
10d.Assess pts. level of anxiety
10e. 17.Teach pt. about nutrition
11. Administer Zithromax. Assess for therapeutic and side effects.
12. Provide pt. with supplement
Ensure PO TID
13.Refer pt. to dietician
14. Assist patient with feeding, open the containers.
14.Obtain Pts. labs
a.HGB
14b.albumin
14c. transferrion
14e. calcium.
14f. sodium
14g.potassium
1. A change in vital signs may indicate fluid, electrolyte, and acid – base imbalances. Tachycardia is a sign of hypovolemia. Irregular pulse may occur from electrolyte imbalances. An elevated temperature may be a result of dehydration or a cause of body fluid loses. Changes in the respiratory rate and depth may cause acid- base balances. Blood pressure may fall with FVD, hypovolemia, or increase with FVE. When a person’s temperature is elevated, hypermeatabolism occurs, and the respiratory rate, heart rate, and basal metabolic rate all increase.
(Kozier pg 1447, Brunner pg 101)
2. A nutritional assessment will identify clients at risk for malnutrition and those with poor nutritional status.
( Kozier pg 1252)
2a. Daily weight is an accurate measurement of pts. fluid status. Significant changes in weight over a short period of time are indicative of fluid changes.
(Kozier pg 1446)
2b. The measurement and recording of all fluid intake and output during a 24hr. period provides important data about the client’s fluid and electrolyte balance.
(Kozier pg 1447)
3. The body obtains energy in the form of calories from carbohydrates, protein, fats, and alcohol. When using a tool to measure intake it allows judgment of overall adequacy and when specific foods or nutrients are suspected of being deficient or excessive.
(Kozier pg 1237 and 1257)
4. Oral hygiene improves the pts. appetite, and improves pts. ability to taste.
( Kozier pg. 1263)
5a. Proteins in the diet provide amino acids necessary for growth and repair of animal tissue.
(Kozier pg 1233)
5b. Carbohydrates are a basic source of energy. Sugars are the simplest of all carbohydrates, are water soluble and are produced by both plants and animals.
Starches are insoluble non sweet form of carbohydrates. Fiber is a complex carbohydrate derived from plants, supplies roughage, or bulk to the diet.
(kozier pg 1232)
5c. Fats are a form of potential or stored energy. Fats are also protein spearers. And provide insulation for heat loss. Fat is needed for absorption of sat soluble proteins
(Kozier pg 1233)
6. Smaller meals help improves pt. appetite and does not discourage pt. from eating.
(kozier pg 1263)
7. Offering a pt. their food preference will improve pts. appetite with the pt. being familiar to food.(Kozier pg 1263)
8. A tidy clean environment that is free of unpleasant sights and odors will improve appetite.
(kozier pg 1263)
9. Treating schizophrenia or bipolar disorder. It may also be used for other conditions as determined by the doctor.
Seroquel is an atypical antipsychotic. Exactly how it works is not known. It affects certain receptors in the brain. This may help to improve symptoms associated with schizophrenia and bipolar disorder. Severe allergic reactions: (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); confusion; fainting; fast, slow, or irregular heartbeat; fever; increased saliva production or drooling; increased sweating; memory loss; menstrual changes; muscle pain, weakness, or stiffness; new or worsening mental or mood changes (eg, depression, hallucination); numbness or tingling; persistent, painful erection; seizures; severe or prolonged dizziness or headache; shortness of breath; swelling of the hands, legs, or feet; symptoms of high blood sugar (eg, increased thirst, hunger, or urination; unusual weakness); tremor; trouble concentrating, speaking, or swallowing; trouble sitting still; trouble walking or standing; uncontrolled muscle movements (eg, arm or leg movements, twitching of the face or tongue, jerking, or twisting); vision changes.
(#10)
10a. It reveals the clients general cerebral function. The functions it includes are intellectual and emotional.
(Kozier pg 642)
10b.According to Erickson the developmental task at this time is ego VS. despair. People who obtain ego integrity view life with a sense of wholeness and derive satisfaction from past accomplishments. They view death as an acceptable completion of life. People who experiences despair often believe they have made poor choices during life and wish they could live life over.
(Kozier 416 and 417)
10c Establishing pts. orientation determines if the pt. has the ability to recognize other persons, awareness of when and where they presently are, and who they are themselves.
level of consciousness can lie anywhere a long a continuum from a state of alertness to a coma. A fully alert pt. responds to questions spontaneously and a pt. comatose may not respond to verbal stimuli.(Kozier pg 643)
10d.A person with mild anxiety can learn to alter lifestyle habits, more severe anxiety can be paralyzing. Pts. experiencing anxiety may be worried and therefore unable to focus on complete essential self care activities.
(Brunner pg 116)
10e. Adequate nutrition provides the body with nutrients. Nutrients have three major functions: providing energy for body processes and movements, providing structural material for body tissues, and regulating body processes.(Kozier pg 1232)
11. Treating infections caused by certain bacteria.
Zithromax is a macrolide antibiotic. It slows the growth of, or sometimes kills, sensitive bacteria by reducing the production of important proteins needed by the bacteria to survive. Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bloody stools; chest pain; dark red raised areas of the skin; hearing loss; pounding in the chest; ringing in the ears; severe diarrhea; stomach cramps/pain; yellowing of the skin or eyes. (#12)
12. Nutritional supplements are often given to pts. Who are malnourished or have poor eating habits. They are high in protein and potassium.(kozier pg 1455)
13. A dietitian has special knowledge about diets to maintain health. A dietitian may design special diets to meet individual needs of pts.(Kozier pg 106)
14. Some clients are unable to open lids of containers of even to hold a spoon. They require assistance. (kozier, 1236)
14a. Low hemoglobin may be evidence of iron deficiency anemia.(Kozier pg 1258)
14b. A low serum albumin level is a useful indicator of prolonged protein depletion.
(Kozier pg 1259)
14c. Transferrin responds more quickly to protein depletion than albumin. Transferrion levels below normal indicate protein loss, iron deficiciency, hepatitis, and liver dysfunction.
(kozier pg 1259)
14e. A depletion of calcium can cause tetany with muscle spasms and paresthesias and can lead to convulsions.( Kozier pg 1441)
14f. Regulates water balance and assist in nerve impulses and muscular contractions.
(Kozier pg 1438)
14g. It is vital to normal neuromuscular and cardiac function.
(Kozier pg 1438)
1.I assessed VS to be
BP – 125/62
HR – 78 regular bounding
RR 22, regular deep, not labored
T 97.8
2. I assessed nutritional status (results below)
2a. Wt – 98lb
Ht – 5’2
2b. Intake – 60 oz of water while in my care.
Output – unable to determine due to incontinence. I&O wasn’t preformed by staff
3. Calorie count was performed daily, according to record pt was ingesting about 1500.
4. I performed oral hygiene before I tried to feed the patient.
5a. patient was provided with ensure pudding and pureed cheeseburger. She ate cheeseburger, but refused to eat ensure
5b. patient was provided with mashed potatoes, orange juice and apple sauce for lunch. She had apple juice left from breakfast. She ate mashed potatoes and asked to put a straw in her juice, but didn’t drink it when I was there. She refused to eat apple sauce, ate one spoon and said it doesn’t taste right. I brought fresh apple sauce but she refused to eat it she also had pureed vegetables, but only ate one spoon, she might have eaten more after I left, but she didn’t seem to like them.
5c. pt’s lunch had a lot of butter, meat, mashed potatoes and vegetables all had butter on them
6. I provided the patient with small frequent meals. I gave Mrs. JG ensure and apple sauce, which she refused. I removed some items from the tray and put it away for later.
7. I was unable to provide the pt. with food preferences, but to her confusion. She tried to explain to me what she wanted, but was unable to express her thoughts. I asked her about foods that were served and removed from the tray foods she said she didn’t want.
8. I provided am care and checked whether or not patient was incontinent before meal was served. Bed pans were not in sight and no foul odors were present. Patient was sitting in the chair during lunch instead of sitting in bed
9. Primary nurse administered Seroquel. Unable to determine effectiveness due to lack of time and information about condition prior to medication administration.
Patient didn’t have signs of side effects. Pt. was oriented to time only, was confused. Therefore teaching couldn’t take place.
10. I assessed mental status. Patient had dementia and depression. She expresses desire to die
10b. I assessed developmental level to be older adult and negative resolution of integrity vs. despair task. She appears hopeless and stated that the only thing she can do is to die.
10cPatient is alert and oriented to time only
10d Patient is anxious about “bumps” she found on her body and about inability to express her thoughts (moderate anxiety)
10e. Unable to teach due to patient’s lack of ability to retain information.
11. Zithromax was administered by primary nurse. No signs of allergic reaction are present. Unable to determine effectiveness due to lack of lab data. However I would’ve obtained C&S studies and WBC count to determine effectiveness of this medication. Teaching was not initiated due to patient’s inability to learn new information
12.Patient was provided with Ensure pudding TID, however she didn’t like the taste and refused to eat it
13. Pt. had a dietary consult which determined dysphasia and FTT
14. I opened containers and placed them closed to the patient, pt. was able to hold the spoon and feed herself.
14. Was unable to access results of lab work due to patient’s discharge, however I expect to find RBC and HGB to be low (patient has anemia).
No signs of calcium imbalance was present, therefore I expect Ca to be within a normal range.
Patient was dehydrated which could be a sign of Na imbalance.
I would pay careful attention to potassium level since patient is presenting some signs of potassium depletion (generalized weakness) potassium imbalance can also be very dangerous due to it’s effect on the heart muscle.
Albumin and transferrin should be within a normal range if the pt. was consuming as much protein as she was while in my care. Transferin levels could be outside of normal range due to possible iron deficiency which could be a result of anemia.
Goal not met. I encouraged pt. to eat. I explained the importance of eating however, pt. refused. Pts. appetite remains poor.
1.Pt’s vital signs present no change in nutritional status
2. Patient is underweight and isn’t consuming enough fluid. Fluid is needed to digest food, therefore it is important to increase fluid intake
3. Patient isn’t ingesting enough calories, and has to be encouraged to ingest more.
4. Pt. refused to eat ensure pudding and apple sauce after oral care, stated it didn’t taste right, however ate lunch.
5a.Patient had proteins needed. I didn’t see how much of the meat served she ate, but she seemed to eat meat before any other part of her lunch. I am unaware what she had for breakfast and dinner, but it the pt had as much protein intake during those meals as she had for lunch, she had digested daily protein requirements even though she didn’t have ensure.
5b. patient had some carbohydrates, however should eat more. Carbohydrate intake can be increased by providing juices, however it is harder to increase intake of complex carbohydrates. Fiber supplement has to be considered.
5c. pt. consumed enough fat to absorb vitamins. She shouldn’t eat too much fat to prevent complications of HTN, such as deep vein thrombosis. However she should eat enough lipids to increase weight and prevent heat loss.
6. Patient agreed to try to eat ensure and apple sauce, but after trying them, refused it. When lunch was served, she stated she cannot eat so much, but was more willing to eat after some items were removed from the tray. Unfortunately I can not be sure items I removed from the tray were later given to patient, but even if they weren’t, removing them helped to increase intake since patient wasn’t as overwhelmed be the amount of food she was seeing. It also helped to eliminated least need foods, such as simple carbohydrates.
7. Pointing out foods and asking the pt. whether or not she liked it worked much better then asking her what she liked. She became very aggravated when she was unable to explain what she wanted, but was calm when I was asking her which foods from the tray she wanted to eat.
8. Patient seemed to eat well and seemed comfortable.
9. Patient is confused, but able to follow the commands and make decisions. Although Seroquel proved to be effective in treating depression, Mrs. JG appears to be depressed and hopeless.
10a.Due to dementia, patient I unable to learn. Patient is confused and therefore cannot retain information provided
10b. Pt. can not be taught due to lack of desire to return to maximum level of activity.
10c. patient can not be taught due to confusion
10d. patient is too anxious to learn
10e. If the teaching would’ve taken place, I would have determined effectiveness of learning by asking questions about nutrition and in long term observed for healthy food choices according to content taught.
11. Not enough time was given to determine effectiveness of Zithromax in decreasing caloric requirements, however, over time I would expect weight gain.
12. Different flavors have to be offered to determine preferences and encourage pt. to eat.
13. Pureed diet was ordered for the pt.
14. Pt. was able to eat and started to ask me to open certain containers and to put a straw in juice. It appeared she had difficulties holding the spoon, but I didn’t try feeding in order to promote ability to care for self.
14. This lab values would be helpful in determining possible supplements patient might need as well as effectiveness of treatment and other factors that could contribute to malnutrition.
Subscribe to:
Posts (Atom)
Posts
