see doc below
NSC 325L- Medical Nutrition Therapy Lab
NFPE Patient Simulation
50 Points
Name: ____________________________________
Part I: Video Evaluation
View the video demonstration of a nutrition assessment in this week’s content page. This video was recorded in the simulation laboratory at the Arizona Simulation Technology and Education Center on the UA campus and the visit was performed with a high-fidelity simulator. The patient has been diagnosed with failure to thrive and dehydration. The RDN has received a consult to assess the patient for malnutrition due to weight loss.
After reviewing the video identify what was done incorrectly during the interaction. What should the RDN have done differently? Was the technique correct? How did the interview go? Was the RDN’s description of the findings accurate? If not, provide the correct description. Did the RDN miss anything?
Here is a list of things to consider when evaluating the video:
Did the RDN …
· Greet and introduce themselves?
· Address the client?
· Clearly explain the nature and purpose of the consult?
· Establish rapport?
· Provide a clear explanation of the NFPE?
· Obtain consent for interview and NFPE?
· Ask appropriate questions to supplement data provided in the case?
· Use open ended questions when appropriate?
· Actively listen to the client and show empathy?
· Demonstrate a respectful, non-judgmental approach?
· Consider and explore the patient’s culture, values, and beliefs?
· Communicate appropriately verbally and non-verbally?
· Continue to build rapport with patient?
· Conduct the NFPE smoothly?
· From head to toe without jumping back and forth from different areas?
· Include all components of NFPE?
· Demonstrate appropriate technique?
· Accurately identify regions for examination and palpation?
· Ask appropriate questions to supplement exam as needed?
· Communicate appropriately with patient during the exam?
· Identifies abnormal findings to address with care team and/or patient?
· Express appreciation?
· Summarize findings?
· Ask if patient has questions/comments?
· Provide a plan for follow-up?
1. Complete your evaluation of the video below: (25 points)
This should be a comprehensive and detailed evaluation addressing the questions above in the directions.
Part II: Complete a Nutrition Assessment
Carol Pacheco is a 79 -year-old female admitted on 8/1/25 for dehydration and failure to thrive. She is admitted to the medical unit at her local hospital for treatment and is currently on day 2 of admission. Her family reports poor appetite and progressive weight loss over the past 6 months.
Medical history: a-fib, HTN, GERD, hyperlipidemia, depression, COPD
Medications at home: Sertralin, lasix, lipitor, metoprolol, prilosec, symbicort
Tobacco use: none
Alcohol use: 1-2 glasses of wine per week
Family history: mother – Alzheimer’s disease; father – CVD
Demographics: recently widowed- 1 year, lives alone, English speaking
Oral mucsosa: dry mucous membranes, no lesions or sores
Eyes: sunken dark circles
Skin: warm, dry, poor turgor, pale
Chest/lungs: respirations normal
GI: hypoactive bowel sounds, scaphoid abdomen
Height: 5′ 4″ (reported)
Weight: 8/3/25- 105 lbs UBW 6 months ago- 130 lbs
8/2/25- 107 lbs
Current medications: prilosec, lipitor, sertralin, warfarin
IV Fluids: NS at 75 ml/hr
Diet order: Low Sodium Diet (2 g/day)
|
PO Intakes Since Admission |
|||
|
Date |
Breakfast |
Lunch |
Dinner |
|
8/3/25 |
25% |
25% |
25% |
|
8/2/25 |
50% |
25% |
50% |
|
8/1/25 |
50% |
50% |
Diet information: lives alone, recently widowed. Appetite poor. Eats most meals alone at home. Has been declining since. Too tired to prepare meals. Does not like her low sodium diet, says it is bland. Reports chewing issues due to dentition- has missing teeth, denies swallowing issues. No food allergies. Prefers Mexican cuisine. Has not tried any oral nutrition supplements.
Reported typical intake in the past months:
Breakfast: Tea (decaf ~10 oz) and 1 slice whole wheat toast with margarine (tsp) and jelly (1 tsp)
Lunch: Cheese and chicken quesadilla or soft tacos (meat and cheese) or chili soup, 8 oz water Dinner: Usually eats lunch late so has little appetite for dinner.
Drinks: Water throughout the day
I/Os: prior 24 hours: 1200 mL / 850 mL
Stool: none
|
NFPE Findings |
|
|
Skin: Pale, dry |
Orbital region: somewhat hollow look, dark circles |
|
Eyes: pale conjuctiva, sunken |
Temple region: slight depressions |
|
Nails: Koiloynichia |
Clavicle bone: some protrusion visible |
|
Mouth: Chelosis, somewhat dry mucous membranes, fissured tongue |
Interosseus muscle: slightly depressed |
|
Dysphagia screen: WNL. missing teeth, difficulty chewing |
Edema: bilateral 1+ pitting edema to feet |
|
Lab Ranges |
8/2/25 |
8/3/25 |
|
Sodium 136-145 mEq/L |
145 |
142 |
|
Potassium 3.5-5.1 mEq/L |
3.1 |
3.0 |
|
Chloride 98-107 mEq/L |
105 |
103 |
|
Bicarbonate 23 mEq/L |
23 |
23 |
|
BUN 6-20 mg/dL |
14 |
13 |
|
Creatinine 0.6-1.1 mg/dL |
1.1 |
1.1 |
|
GFR >60 mL/min/1.73m2 |
75 |
|
|
Glucose 70-99 mg/dL |
101 |
105 |
|
Phosphate 2.2-4.6 mg/dL |
2.4 |
2.2 |
|
Magnesium 1.5-2.4 mg/dL |
1.7 |
1.8 |
|
Calcium 8.6-10.2 mg/dL |
8.9 |
|
|
Albumin 3.5-5.5 mg/dL |
5.3 |
|
|
Alkaline phosphatase 30-120 U/L |
50 |
|
|
ALT 4-36 U/L |
21 |
|
|
AST 0-35 U/L |
17 |
|
|
Cholesterol <200 mg/dL |
89 |
|
|
HDL >50 mg/dL |
51 |
|
|
LDL-C <130 mg/dL |
75 |
|
|
LDL/HDL <3.22 |
1.22 |
|
|
Triglycerides 35-135 mg/dL |
130 |
|
|
WBC 3.9-10.7 x 103/mm3 |
7.9 |
|
|
Hemoglobin 12-16 g/dL |
11.0 |
|
|
Hematocrit 37-47% |
34.4 |
After reviewing the information above, complete a nutrition assessment for this patient. Be clear and concise- only include information relevant to your assessment. Include the ABCD criteria for your assessment. (10 pts)
Create a nutrition prescription for this patient: (2 pts)
Show your work for calculations.
Kcal:
Protein:
Fluid:
Fiber:
Create 2 PES statements for this patient: (6 pts)
P:
E:
S:
P:
E:
S:
Create 2 SMART nutrition goals: (2 pts)
List 2 nutrition interventions (2 pts)
Interventions should match your PES statements and goals.
What are you going to want to monitor for this patient? (1.5 pt)
What is your plan for follow-up with this patient? (1.5 pt)
