Running head: CASE STUDY 14

Lesson 14 Case Study

Implement Physicians Dietary Orders
Angela Martin
United States University

CASE STUDY 14

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Lesson 14 Case Study- Coach K

Introduction
Ms. K has lived at College Town Nursing Home for 18 years. She is a retired womens
basketball coach at State College. Everyone calls her Coach K. She is 94 yr old.
Active Diagnoses: mildly impaired cognitive function, gastro esophageal reflux disease

(GERD), dysphagia
Historic Diagnoses: gallbladder surgery 30 years ago, depressive disorder, CVA 2 years

ago
Other Physical Findings: Uses walker to ambulate. Coach K doesnt like to take
medicine. She refuses to take medications with water. Nursing offers pudding as a
medium to swallow medicines. Coach K has 24 natural teeth. Oral exam shows two small

abnormal masses in her mouth.

Nutrition Prescription: Pureed Diet, 2 mg NA, nectar thick liquids
Food & Nutrition History: Intake over the last 3 days
Food: 90% breakfast, 20% lunch, 50% HS snack
Fluid: average fluid intake 600-800 mL/d.
Meals served provide about 1800 Kcal, 64 gm protein/day. Average nutrient density of
meals noted in table.

1. What is her percentage weight change in 30 and 365 days ago?

30 Days Ago
Percentage Weight Change 133-125 / 125 = 6.4%
365 Days Ago
Percentage Weight Change 145-125 / 125 = 16%
2. What is her estimated protein need?
Estimated protein need of Coach K is 66 grams.
3. How does Coach Ks average dietary intake compare to her energy and protein needs?
Use the nutrient analysis data from the menu and the food intake data to determine her
average intake of calories and protein.
Coach Ks daily dietary intake shows that she is consuming on 20 grams of protein
while she needs 66 grams. This shows a protein deficiency in her diet.

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% Meal Eaten Kcal Consumed Protein Consumed
Breakfast
360
10.8
Lunch
100
4.2
Supper
0
0
HS Snack
100
5
Totals
560
20

4. What do her labs suggest?

Coach Ks lab reports show that her protein level is above normal and she does not have a
protein deficiency.
5. How would you complete these sections of the MDS? Circle all that apply.
K0100. Swallowing Disorder
A. A. Loss of liquids/solids from mouth when eating and drinking
B. Holding food in mouth/cheeks or residual food in mouth after meals
C. Coughing or choking during meals or when swallowing medications
D. Complaints of difficulty or pain when swallowing
Z. None of the above
K0300. Weight Loss
B. Loss of 5% or more in the last month or loss of 10% or more in 6 months
0. No or unknown
1. Yes, on physician-prescribed weight loss regimen
2. Yes, not on physician-prescribed weight loss regimen
K0500. Nutritional Approaches
C. A. Parenteral/IV feeding
B. Feeding tube- nasogastric or abdominal (PEG)
C. Mechanically altered diet require change in texture of foods or liquids (e.g.
pureed food, thickened liquids)
D. Therapeutic diets (e.g. low salt, diabetic, low cholesterol)
Z. None of the above
6. What other member of the IDT would you talk with about meeting Coach Ks nutrition
needs?
I will discuss with Coach Ks nurse and physician about her nutrition needs and
requirements.
7. As the CDM, what are some things you can do to meet Coach Ks nutrition needs?
The certified Dietary Manager works as a full time employee of a medical facility and is
responsible for providing daily oversight of nutrition services. As a Certified Dietary Manager I

CASE STUDY 14

will help Coach K in meeting her nutrition needs by identifying her nutrition problem which is
insufficient fluid intake, gradual weight loss and inadequate protein in her meals. I will further
implement physicians diet order based on her nutrient need.
8. Write a care plan for Coach K identifying 1-3 nutrition problems.
Nutrition

Status

Care Plan

Problem
Weight Loss

Coach K lost 20 Pounds in a

Coach K must be motivated to increase her food

year.

intake and especially she should be advised to

Protein

Coach K is consuming 20

consume supper meal as well.

Coach K must be on a high calorie diet.
Portion of Coach Ks Meal should be increased.
Coach K must be given foods high in

Deficiency

grams of protein while she

calories/protein that will promote weight gain and

needs 66 grams.

protein balance such as meat, fish, cheese, tofu,

Fluid

Coach Ks average fluid

beans, lentils, yogurt, nuts, and seeds.

Visitors of Coach K, Twin sister or Younger

Deficiency

intake 600-800 mL per day

brother must be encouraged to have a drink with

while normal range is 2200

her or offer her drink.

Offering a full glass of water when giving

mL per day
medications to Coach K and keeping a water jug
close to her bed.
Reminding or prompting Coach K to start her
meals with a glass of water.