Professional Documents
Culture Documents
• Dietitians attend rounds in the ICU/ CCU with the interdisciplinary team
• There is no cure
Causes and Symptoms of PM
• Unknown cause, more research needs to be done
• Shares similar characteristics to an autoimmune disease
• Corticosteroids
• Immunosuppressive drugs
• Nutrition support
About this patient:
Age: 74
Gender: Female
Admit weight: 187# (84.822kg)
Height: 5’3” (1.6m)
BMI: 33.1
Medical history: Afib, hypothyroidism, HTN, chronic pedal edema, fatty liver, G-tube placed
6/2018, uterine CA
Family history: Mother with MS, breast CA and multitude of heart diseases. Father with
enlarged heart and rheumatoid arthritis. Brother with prostate CA. Sister with Parkinson’s
disease.
Weight history: Patient previously weighed 210# ~2 months ago, now she has a stated weight
of 187# upon admission. This indicates a 23# (11%) wt loss in 2 months.
5/25/18 Admission to Holy Family Hospital
• Transferred from Merrimack Valley Hospital for upper and lower extremity pain
and weakness as well as some difficulty swallowing ongoing for about 3 weeks.
• Describes her pain as going across her upper back and her shoulders, down her
elbows.
• Difficulty getting up and moving around.
• Limited range of motion in lifting her arms that is progressively getting worse.
• Inability to lift her legs to climb stairs, or get out of bed.
• Inability to flex at the elbow and feed herself.
• Weight loss of 14 pounds in 9 days per patient report, loss of appetite.
• Trouble swallowing, choking and gagging on foods. Has to drink water and
swallow 2-3 times for food to go down.
MD note: 5/29 tube feeds through NG tube. She will be
discharged to rehab and reevaluate with outpatient through
neurology and rheumatology. If patient continues to have trouble
with swallowing then she may require a PEG tube. I explained this
to the patient and she indicated understanding.
Diet history:
-This patient had always eaten a regular diet before her diagnosis, avoiding salt for heart health
-In June, upon a previous admission, SLP did not clear this patient for PO intake. During that admission she had a
PEG to placed and was to start continuous nutrition support via the PEG tube. Patient was discharged on Jevity 1.2
to rehab facility.
-On 7/6, I was able to watch her outpatient MBS where SLP recommended a dysphagia advanced diet with honey
thick liquids.
-Patients diet was advanced at rehab facility to soft foods, thin liquids without a follow up MBS, still using the PEG
tube with Jevity 1.2 for some feeding per patient report.
-Patient was discharged from rehab facility without nutrition support and now arrives to the ER via ambulance
with failure to thrive/ unable to ambulate directly related to nutritional status.
“The patient will be admitted to the Medical Floor. She will get a PT evaluation as she is
still unable to ambulate. We will consul neurology, and get a Nutrition consult for
calorie counts and feeds. She may need to supplement on what she is eating with
further G-tube feeds. I would like to give her a little bit of fluids overnight because she
has not been eating or drinking great, but she does have pedal edema, so I will
continue the Lasix as well. I would like to have speech see her because her MBS on 7/6,
based on that she was supposed to be on a dysphagia advanced with honey-thick
liquids, but now she is doing a soft diet with thin liquids and apparently there is no
coughing or choking per the ED nurse, but I would like to have speech follow up.
Patient understands plan of care.”
7/31:
RN noted that PEG did not seem to be in the right place, or perforating the
gastric remnant. KUB with contrast imaging was ordered.
Over the past month, this patient had developed a stage I pressure ulcer on her
coccyx, and stage I + II pressure ulcers on her right middle buttocks.
Nutrition Assessment:
Age: 74
Issues affecting oral intake: Weakness, Dysphagia
Gender: Female
Admit weight: 187# (84.822kg)
Wt Hx: All reported wt, no actual wt in EMR. Wt loss of 23# (11%)
Height: 5’3” (1.6m)
in 2 months
BMI: 33.1
UBW: 210# per pt report
%UBW: 89% Intake needs:
IBW: 115# 1813-2116kcal (30-35kcal/kg adj bw)
%IBW: 162% 79-90g (1.2-1.5g/kg adj bw)
ABW: 133# 2120mls (25mls/kg)
Will meet 100% of RDIs through nutrition support, recommend
250mg Vit C for wound healing
Reason for admission: Lower extremity weakness, unable to ambulate, poor PO intake, failure to thrive
PES statements:
Interventions:
1: Will provide TF recommendations to cover 100% of nutritional needs
Recommendations:
1. Recommend TF/ Oral diet w/ oral diet texture per SLP recs, liberalize diet to regular-
-Initiate TF to cover 100% of needs w/ encouraged PO intake at meals. Initiate Jevity 1.5 @ 25mls/hr,
increasing by 15mls q6h as tolerated to goal rate of 60mls/hr x24 hrs w/ 180ml free water flush q4h
@ goal to provide 1980kcal, 84g protein, 2083mls total free water.
-Please hold TF for 1 hour before and after Synthroid dosing
2. Recommend bowel regimen, monitor BMs
3. Obtain actual wt, all wt’s in EMR are stated
4. Recommend d/c MVI, pt to receive 100% RDIs through TF regimen
5. Recommend 250mg Vit C/ day for wound healing.
Nutrition related goals:
1. No further wt loss (+/-2%) – Established
2. Tolerated TF at goal rate –Established