I presented my capstone at University Hospital and Clinics to 3 dietitians (purple scrubs), 2 Diabetic Nurse Educators (blue scrubs), and 2 Food Service Mangers (end of the left and right)
University Hospital & Clinics
Objective The Clinical Case Report provided the intern an opportunity to practice in-depth analysis, application of the Nutrition Care Process and use the AND evidence analysis library in practice. A major case report was submitted towards the end of the clinical rotation to show evidence of the intern's application of the NCP and evidence-based practice in a complex adult case concerning critical illness requiring nutrition support.
Abstract: Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Little research exists on dysphagia in brainstem stroke worldwide. The Lateral medullary syndrome is not a very common stroke. Mr. MJ, 64 year old African American male, non-diabetic, non-hypertensive, but smoker presented with shortness of breath, respiratory failure with an O2 saturation of 84%, and dizziness. He was clinically and radiologically diagnosed with a case of Lateral Medullary Syndrome (Stroke). Speech and physical therapy treatment for this patient is ongoing at a long-term rehabilitation center.
The paper also documents two cases of the severity and management approaches of dysphagia in brainstem stroke. For the first patient, cranial MRI had shown an acute ischemic stroke in the left lateral medullar region and the diagnosis of Wallenberg syndrome was established. The patient is administered PEG feeding after the diagnosis followed by a progressive rehabilitation to food intake. For the second patient, clinical dysphagia evaluation was done by a dysphagia specialist, which included a detailed history of the subjective complaints and medical status, cranial nerve testing, and an examination of the phases of swallowing. Cervical auscultation and respiratory status examination were also conducted. The patient was administered a traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe forms of dysphagia followed by different treatment interventions, both patients had complete recovery of the swallowing function.
Competencies Met
CRD 1.2 Apply evidence-based guidelines, systematic reviews and scientific literature (such as the Academy’s Evidence Analysis Library and Evidence-based Nutrition Practice Guidelines, the Cochrane Database of Systematic Reviews and the U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, National Guideline Clearinghouse Web sites) in the nutrition care process and model and other areas of dietetics practice.
CRD 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 Dietetics Practice and Code of Ethics for the Profession of Dietetics.
CRD 2.10 Establish collaborative relationships with other health professionals and support personnel to deliver effective nutrition services.
CRD 3.1 Perform the Nutrition Care Process (a through e below) and use standardized nutrition language for individuals, groups and populations of differing ages and health status, in a variety of settings.
CRD 4.5 Use current informatics technology to develop, store, retrieve and disseminate information and data.