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Assignment Introduction:
Imagine that you are a nutrition assistant working at a pediatric rehabilitation center. This rehabilitation center provides care for pediatric patients who are recovering from recent hospitalizations. This facility is considered to be the bridge between critical care type hospitals and home care.
The supervising dietitian informed you that a new patient was admitted overnight from the nearby hospital and is now recovering from a skin graft surgery due to a severe pressure ulcer (bed sore). Imagine that you are asked to review the patient’s chart notes and provide a nutrition assessment summary along with recommendations for a therapeutic diet or nutrition support (i.e., either enteral or parenteral nutrition with or without an oral diet).
Patient information from the hospital medical chart:
Name: Cindy
Age: 6-year-old female
Height: 42.5 inches
Weight: 37 pounds
Admitting diagnosis (Dx): Cerebral palsy, bedridden, stage 3 pressure ulcer on sacrum, food allergy to eggs
Surgery: Skin graft performed to increase healing and reduce further infection risk.
Diet order: Thickened liquids and pureed foods with precautions due to dysphagia (swallowing deficiencies) associated with CP. No eggs: Egg Allergy.
Speech/Cognitive: Patient receives speech & swallowing therapy due to CP. Her speech and cognitive abilities were reported to be around that of a 2-year-old.
Cindy typically lives at home with her family. She qualifies for state-funded home health/medical care assistance due to the CP diagnosis. She is bedridden and relies on the home health nursing assistants for all of her care. Her parents have three other children and involve her in as many family activities as possible, but the actual health care is provided by the in-home health team. Cindy has had a gastrostomy feeding tube (G-tube) since she was just a few months old. It is to be used nocturnally if her intake of pureed/soft diet foods falls below the 50% mark for two or more meals. She received a specialized enteral tube feeding formula without eggs as any source of the protein.
For many years, Cindy was cared for by the same team of nurses and nursing assistants, and she did not have any major medical or nutrition-related problems. However, about 5 months ago, the state-funded program changed home health contract companies, and a new company and nurses/nursing assistants began to provide care. Cindy’s parents felt the care was substandard and reported it numerous times, but without any improvements. It was not until Cindy’s quarterly checkup that these problems were identified. Her weight had dropped by 15% in just 3 months, her albumin was low, and her lean muscle mass and general strength tests had decreased. Most alarmingly, she had developed a pressure ulcer (stage 3) on the sacrum. The MD immediately admitted Cindy into the hospital.
Upon further investigation, the new home health company had been administering nocturnal tube feedings with a formula that contained egg as one of the sources of protein. They thought that it was a comparable and appropriate substitute for the previous brand/type of enteral formula. Additionally, they had misread or generalized the original diet order to only give night enteral feedings (via the G-tube) if her oral intake was “insufficient.” Until the issues were discovered, Cindy went several months receiving a full night of tube feedings that provided a feeling of fullness to her. She also was suffering from chronic diarrhea and associated malabsorption. Subsequently, she would not feel well enough to eat the next day, and the cycle repeated itself daily. She also started having many more nasal and respiratory symptoms, which the new care providers explained away as being typical seasonal allergies. She was prescribed an antihistamine. Her parents were unaware of the consistent nocturnal tube feedings because the nursing staff ran the feedings for 8+ hours (after the parents said good night to their daughter).
Instructions:
From the case scenario above, please answer the following questions:
Questions to address:
What are two risk factors associated with pressure ulcer development? What were some of the contributing factors in Cindy’s case? Include supporting evidence.
What are 2 symptoms associated with an egg allergy? Why was her allergy not life-threatening when she was receiving the nightly tube feedings of an enteral formula with eggs as a partial source of protein? Utilize patient information along with credible references to support your ideas.
Calculate her estimated calorie and protein needs. Consider her medical conditions of cerebral palsy, egg allergy, and recent pressure ulcer surgery.
Recommend an appropriate tube feeding formula brand name or type that has no albumin from egg protein (to use as nocturnal tube feeding when she has inadequate oral daytime meal intake).
Appendix: Design a full-day pureed/soft sample menu. Consider her protein needs for wound healing promotion & future wound prevention, but without foods containing eggs. Oral protein drink supplements can be considered. Please include: food descriptions, serving sizes, total calories, total carbohydrates, fats, protein, and any micronutrients (vitamins/minerals) that are important in this case.
Requirements: Please include the answers to questions 1–4 in an essay of at least 2 pages. Incorporate at least three references in APA style within the essay. Part 5/Appendix should be formatted as a well-organized 1-day sample meal plan with a detailed description of the food items, serving sizes, and the daily calorie/nutrient totals. The meal plan is in addition to the 2 pages for questions 1–4.
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