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Nutrition Case Study

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In this essay my objective is to explore the management of my chosen clients nutritional needs.

Nutrition is the basic source of energy that provides your body with the energy to perform, it is essential to enable your health to maintain the nutrients ,they required and vital to ensure your body's growth and repair. (BBC 2009)

Due to the purpose of this essay I was required to gain permission from the patient. The (NMC 2008) states, "you must respect the right of confidentiality with patients." Due to this patient being under the Adults with incapacity (Scotland) Act 2000 he was safeguarded and assigned a guardian due to his lack of capacity to make decisions for himself. Therefore it was essential that I gained full consent from his named guardian. I liaised with the patients assigned guardian and gained permission. I will be using a false pseudonym for my patient to protect his identity and privacy. The (NMC 2008) states, "confidentiality and consent are paramount in nursing". I have chosen the false name Mr X to ensure his privacy is met.

Mr x was admitted into care of the hospital in 1994, with no family involved meaning an assigned nurse gained a guardianship order due to him being incapable making his own informed decisions and choices. RCN (2008) When Mr x was originally admitted into hospital he was fully mobile and independent with no nutritional needs and was fairly healthy.

Mr x had suffered a Cardio Vascular stroke, which had left him with Dysphagia. Dysphagia occurs after damage to the central nervous system. Dysphagia is described as having difficult swallowing or discomfort when swallowing, and can cause lots of complications, including dehydration and malnutrition. Both are a result of the increased effort involved when eating or drinking. Dietetics (2009)

Due to Mr x finding it difficult to take medication the nurses had to obtain a covert medication pathway care plan ,to ensure that he receives his medication. Mental Wealth Commission (2002)

Using clinical judgement the nursing staff were able to identify within Mr X signs of malnourishment and dehydration. These signs included, extreme lethargy, Mr X would regularly sleep the entire day, and would only wake up to eat after encouragement from a member of staff. Mr X also lost an alarming amount of weight, dropping from 54kgs to 37.2kgs with a BMI of 18.5 in a short period of time. (demonstrated in the must tool.)

The "Must" tool is a five step screening tool that identifies individuals who are malnourished, or at a high risk of malnutrition. It includes the management guidelines which can be used to develop a care plan. It was developed by Bapen to complete more information on malnutrition and its impact on clinical outcome.

Due to Mr X's central nervous system being damaged after a stroke, he suffered from dysphagia which put him at risk of malnourishment and dehydration.

Using a combination of the Malnutrition Universal Screening Tool and the Five Step Risk Assessment the multi disciplinary teams, which consisted of a speech therapist, dietician, nursing staff and hospital catering staff, the team were able to identify that Mr X was at risk of severe malnourishment. Using the steps set out in these tools, the multi disciplinary team were able to tailor an action plan to suit Mr X's personal needs. This action plan was reviewed on a three weekly basis, where the multi disciplinary team would look at his three day food plan and a food and fluid chart. The team also used to Malnutrition Universal Screening Tool (must tool 2006) to help them re-evaluate their assessment of Mr X and make any necessary adjustments.

Mr X's dietician came up with a few strategies to help manage his nutritional needs after analyzing his updated Malnutrition Universal Screening Tool assessment and risk assessment. These strategies included positioning Mr X so that he wasn't facing anyone during meal times, as people watching him eat made him feel uncomfortable. The dietician also suggested that different members of staff approach Mr X during meal times as everyone had different personalities and approaches. On top of this it was suggested that Mr X consumed two bottles of ensure per day, and that full fat milk and cream were added to appropriate foods to help Mr X maintain a healthy nutritional state. Dieticians Say that this adds extra calories to there foods as they are not receiving enough through there



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