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Instructions:

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.

1. 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).

2. 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 up-right 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 our textbook. (Refer to page 254 for general ideas and Tables 7.1,

7.3 and 7.4).

3. 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?

4. 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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