CLINICAL

DIETETICS
PRACTICUM I
Manchester Manor
December 3, 2014
DIET 3155
Esha Fletcher

PATIENT
Name: AC
Age: 85

BMI: 19.4 (normal)

Sex: Female

IBW: 115 (105-125)

DOB: 7/23/29

%IBW: 95%

Race: Caucasian

Admission Date: 10/15/14

Height: 53 or 63 inchesDate Seen: 10/29/14

Weight: 109.4 lbs or 49.6 kg

NUTRITION HISTORY
She has a small appetite, eats less than half of her food

(25-50% consumption)
She is able to feed herself and likes eating in the dining

room if she feels well

Has difficulty swallowing foods, must swallow foods

slowly
Complains of normal food getting stuck in throat
No known food allergies

CHIEF DIAGNOSIS
Dysphagia Oral Phase
Definition: When patient has difficulty swallowing

meaning it takes more time and effort to move food or

liquid from the mouth to the stomach. Patient is usually
referred to a speech or swallowing therapist where
exercises are used to coordinate swallowing muscles and
trigger swallowing reflexes, along with learning to
swallow techniques.

Can lead to:

Malnutrition

Dehydration

Respiratory Problems

MEDICAL NUTRITION THERAPY

Recommend protein supplement (i.e Ensure Plus)
Thickener added to liquids
Swallowing Therapy
Dietary changes: Mechanical Soft Foods
If needed, Feeding Tubes to prevent malnutrition

OTHER MEDICAL DIAGNOSES

Anxiety State

Atrial Fibrillation

Pneumonia

Congestive Heart Failure

Thyrotox w/o Goiter

Hyperlipidemia
Dementia
Essential Hypertension
Polymyalgia Rheumatica
Muscle Weakness

(CHF)
Chronic Airway

Obstruction (COPD)
Urinary Tract Infection
Difficulty Walking
Osteoporosis
Malignant Neoplasm of

Breast

SIGNIFICANT MEDICATIONS
Ensure Plus: supplement; 350 calorie supplement/meal

replacement, has essential nutrients to meet daily calorie

total and increase protein
Megestrol Acetate: Poor Appetite; Used to increase your

appetite and to prevent or reverse significant weight loss

Potassium Chloride: Supplement; Monitor serum K, Cl, Mg

and renal function *Hold if Lasix is held for low BP

Omeprazole: GERD; Treats heartburn, stomach ulcers

and GERD. Patient must avoid alcohol

Lasix: CHF, diuretic; Must take on empty stomach, food

causes bioavailability. Monitor BP, electrolytes, Mg, Ca,

glucose, uric acid, CO2 & renal function

OTHER MEDICATIONS
Atorvastatin Calcium

Hyperlipidemia

Cardura Tablet

HTN

Coreg Tablet

Cardiac Arrhythmia

Digoxin Tablet

Cardiac Arrhythmia

Diovan Tablet

HTN

Donepezil HCL Tablet

Dementia

Isosorbide Mononitrate ER

Tablet

Angina

Methimazole Tablet

Hyperthyroidism

PARoxetine HCL

Depression

Xarelto

Afib

Advair Diskus Aerosol Powder

COPD

Clindamycin HCL

Pneumonia

TREATMENTS/THERAPIES
SLP: Swallow evaluation & consistency with speech

therapist
Recreation Therapy: Musical entertainment, watching TV,

magazines with other residents

BIOCHEMICAL DATA
Lab Name

Patients Results

WBC

91

4.0-10.5

Albumin

2.9

3.5-5.0

BUN

35

7-17

Creatinine

0.8

0.5-1.0

Potassium

3.4

3.5-5.1

Normal Values

DIETARY SIGNIFICANCE
Current Diet Order

Regular Diet

Mechanical Soft Texture

Variety of foods from all food groups, to promote optimum health; no

restrictions
Eliminates foods that are hard to chew & swallow such as raw fruits
and vegetables, chewy breads and tough meats

Nectar Consistency

Thickener is added to drinks to make nectar-like consistency, less

likely patient will aspirate.

Appropriate?

Yes, patient diagnosed with Dysphagia Oral Phase, has

difficulty swallowing and trouble with foods getting stuck.
There is also a need for decreased sodium due to CHF

NUTRIENT NEEDS
Harris Benedict:

1,028 x 1.2 (activity factor)

1,233 + 200 kcal added
= 1,433 calories
Total Calorie Needs: Carbs-55%, Protein-15%, Fat-30%
Possible Obstacles: Dementia, Anxiety State

SAMPLE MENU
Breakfast

Snack

1 small banana

1 slice low sodium

1 scrambled Egg

cheddar cheese

1 cup oatmeal

cup of Ensure

cup Ensure

Dinner

Snack

2 ounce of Fish

1 8oz Chocolate Pudding

1 cup of Low Fat Milk

1 cup of Peas

Lunch

cup Mashed Potatoes

1 cup of Broccoli Cheese

Snack

Soup

1 8oz vanilla yogurt

FOLLOW UP
10/29/14: Original visit with patient, viewed chart and

spoke with patient

11/5/14: First Follow Up
Reviewed chart
Found new medications and orders:

Lasix Tab 20MG, Potassium Chloride Tab 20MEQ

(Increased) and Patient to be supervised for all
meals 11/12/14
11/12/14: Second Follow Up
Labs still the same
No significant changes in weight

NUTRITION CARE PROCESS

Nutrition Diagnosis: Dysphagia Oral Phase
PES Statement: Difficulty swallowing related to

diagnosis of Dysphagia as evidenced by mechanical

soft and nectar thickened liquids diet to reduce risk of
aspiration.
Monitor & Evaluation: Monitor electrolytes, Mg, Ca, BP,

glucose

QUESTIONS?

REFERENCES
http://www.drugs.com/omeprazole.html
http://www.webmd.com/drugs/2/drug-3776-8043/lasix-oral

/furosemide-oral/
details
http://www.mayoclinic.org/diseases-conditions/dysphagia/b

asics/definition/con20033444
http://medical-dictionary.thefreedictionary.com/bolus