Clinical Projects
clinical case report
Nutritional Management Following a Cerebrovascular Accident
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The Clinical Case Report project will provide the intern an opportunity to practice in-depth analysis and application of the Nutrition Care Process (NCP). The case report will show evidence of the intern’s application of the NCP and evidence-based practice in a complex adult case requiring nutrition support. The patient must require either enteral, parenteral, or a combination of both.
CRDN 1.2 Apply evidence-based guidelines, systematic reviews and scientific literature.
CRDN 1.3 Justify programs, products, services and care using appropriate evidence or data.
CRDN 3.1 Perform the Nutrition Care Process and use standardized nutrition language for individuals, groups and populations of differing ages and health status, in a variety of settings.
CRDN 3.2 Conduct nutrition focused physical exams.
A cerebrovascular accident (CVA), also referred to as a stroke, occurs as a result of brain damage due to interruption of blood flow to the brain. Stroke is one of the leading causes of death and disability in the United States. It may also lead to other complications including difficulties walking, pronouncing words clearly, and swallowing. One such case is of a patient admitted to a local acute care facility with a diagnosis of acute CVA and the resulting diagnoses of hypertensive emergency, aspiration pneumonia, and acute kidney injury. Related comorbidities included morbid obesity, congestive heart failure, hypertension and asthma. After experiencing a stroke, it was determined that the patient had dysphagia and would benefit from tube feeding via enteral nutrition as she would be unable to meet her nutritional and hydration needs orally. An enteral nutrition regimen was prescribed and the patient reported intolerance, claiming a soy allergy. Side effects included nausea, vomiting, diarrhea, and abdominal discomfort. As a result, the patient spent majority of her hospital admission Nil Per Os (NPO) and her enteral nutrition prescription was constantly changing. The patient developed malnutrition during her hospital admission. Through meticulous monitoring and evaluation, the health care team used critical thinking, monitoring and evaluation to provide the patient with the necessary care. The patient was discharged from the acute care facility twenty-six days after admission with a nutrition prescription that she was able to tolerate.
Key words: cerebrovascular accident (CVA), tube feeding, enteral nutrition, malnutrition
Clinical Case Report: Nutritional Management Following a Cerebrovascular Accident
PowerPoint Presentation: Nutritional Management Following a Cerebrovascular Accident
emerging trends in nutrition
Telehealth
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To complete a Journal Review In-Service education reporting on an emerging trend related to an aspect of the Nutrition Care Process.
CRDN 1.4 Evaluate emerging research for application in nutrition and dietetics practice.
CRDN 2.2 Demonstrate professional writing skills in preparing professional communications.
CRDN 3.4 Design, implement and evaluate presentations to a target audience.
CRDN 3.8 Deliver respectful, science-base answers to client questions concerning emerging trends.
Telehealth is the use of telecommunication technologies to provide long distance health care and health education. Telenutrition is the use of telehealth by a Registered Dietitian to implement the Nutrition Care Process. According to the Academy of Nutrition and Dietetics, telehealth is an “emerging area of practice for many health care professionals.” Due to the COVID-19 pandemic, telehealth is being implementing more frequently than ever before.
PowerPoint: Emerging Trends- Telehealth
Journal Article: Telehealth and Nutrition Support During the COVID-19 Pandemic
ETHICS
Ethical and Legal Issues Impacting Dietetics Practice
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To complete a Journal Review In-Service education on ethical and legal issues in nutrition, hydration, and feeding.
CRDN 2.1 Practice in compliance with current federal regulations and state statutes and rules, as applicable, and in accordance with accreditation standards and the Scope of Nutrition and Dietetics Practice and Code of Ethics for the Profession of Nutrition and Dietetics.
CRDN 2.2 Demonstrate professional writing skills in preparing professional communications.
CRDN 3.4 Design, implement and evaluate presentations to a target audience.
As nutrition practitioners it is crucial to abide by the Code of Ethics in our practice. Ethical issues in nutrition, hydration and feeding occur all the time, especially in acute care and long-term care settings. One such case is that of an 85-year-old patient with altered mental status. The RD believed that the ethical thing to do was to put the patient on comfort feeds, and the family wanted to do a PEG placement. Ultimately the family decided to place a PEG. Following the Code of Ethics was critical in providing optimal care to this patient.
PowerPoint: Ethical Issues
CDR Code of Ethics 2018
