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Assignment Introduction:
Imagine that you are a nutrition assistant working at a pediatric rehabilitation center. This rehabilitation center provides care for pediatric patients who are recovering from recent hospitalizations. This facility is considered to be the bridge between critical care type hospitals and home care.
The supervising dietitian informed you that a new patient was admitted overnight from the nearby hospital and is now recovering from a skin graft surgery due to a severe pressure ulcer (bed sore). Imagine that you are asked to review the patient’s chart notes and provide a nutrition assessment summary along with recommendations for a therapeutic diet or nutrition support (i.e., either enteral or parenteral nutrition with or without an oral diet).
Patient information from the hospital medical chart:
Name: Cindy
Age: 6-year-old female
Height: 42.5 inches
Weight: 37 pounds
Admitting diagnosis (Dx): Cerebral palsy, bedridden, stage 3 pressure ulcer on sacrum, food allergy to eggs
Surgery: Skin graft performed to increase healing and reduce further infection risk.
Diet order: Thickened liquids and pureed foods with precautions due to dysphagia (swallowing deficiencies) associated with CP. No eggs: Egg Allergy.
Speech/Cognitive: Patient receives speech & swallowing therapy due to CP. Her speech and cognitive abilities were reported to be around that of a 2-year-old.
Cindy typically lives at home with her family. She qualifies for state-funded home health/medical care assistance due to the CP diagnosis. She is bedridden and relies on the home health nursing assistants for all of her care. Her parents have three other children and involve her in as many family activities as possible, but the actual health care is provided by the in-home health team. Cindy has had a gastrostomy feeding tube (G-tube) since she was just a few months old. It is to be used nocturnally if her intake of pureed/soft diet foods falls below the 50% mark for two or more meals. She received a specialized enteral tube feeding formula without eggs as any source of the protein.
For many years, Cindy was cared for by the same team of nurses and nursing assistants, and she did not have any major medical or nutrition-related problems. However, about 5 months ago, the state-funded program changed home health contract companies, and a new company and nurses/nursing assistants began to provide care. Cindy’s parents felt the care was substandard and reported it numerous times, but without any improvements. It was not until Cindy’s quarterly checkup that these problems were identified. Her weight had dropped by 15% in just 3 months, her albumin was low, and her lean muscle mass and general strength tests had decreased. Most alarmingly, she had developed a pressure ulcer (stage 3) on the sacrum. The MD immediately admitted Cindy into the hospital.
Upon further investigation, the new home health company had been administering nocturnal tube feedings with a formula that contained egg as one of the sources of protein. They thought that it was a comparable and appropriate substitute for the previous brand/type of enteral formula. Additionally, they had misread or generalized the original diet order to only give night enteral feedings (via the G-tube) if her oral intake was “insufficient.” Until the issues were discovered, Cindy went several months receiving a full night of tube feedings that provided a feeling of fullness to her. She also was suffering from chronic diarrhea and associated malabsorption. Subsequently, she would not feel well enough to eat the next day, and the cycle repeated itself daily. She also started having many more nasal and respiratory symptoms, which the new care providers explained away as being typical seasonal allergies. She was prescribed an antihistamine. Her parents were unaware of the consistent nocturnal tube feedings because the nursing staff ran the feedings for 8+ hours (after the parents said good night to their daughter).
●Correctly identifies three reasons why Cindy was at risk for developing a pressure ulcer.
●Effectively explains how the risk factors contribute to skin breakdown by including credible evidence.
● Correctly identifies two reasons why Cindy was at risk for developing a pressure ulcer.
● Explains how the risk factors contribute to skin breakdown on a basic level.
● Correctly identifies one reason why Cindy was at risk for developing a pressure ulcer.
● Does not effectively explain how the risk factor contributes to skin breakdown/ pressure ulcer.
● Does not identify Cindy’s risk factors for developing a pressure ulcer. Does not explain how the risk factors contribute to skin breakdown.
Score of Criterion 1: Pressure Ulcer Risk Factors,
/ 25
Criterion 2Level III Max Points30 points
Level II Max Points
24 points
Level I Max Points
18 points
Not Present
0 points
Criterion Score
Criterion 2: Symptoms of an Egg allergy
● Identifies three or more symptoms of an egg allergy.
● Accurately explains why Cindy’s allergy status was not life threatening by citing supportive and credible sources.
● Identifies two symptoms of an egg allergy.
● Explains why her allergy status was not life threatening, but on a basic level.
● Identifies at least one symptom of an egg allergy.
● Does not fully explain why her allergy status was not life threatening.
● Does not identify symptoms associated with an egg allergy. Does not explain why Cindy’s allergy status was not life threatening.
Score of Criterion 2: Symptoms of an Egg allergy,
/ 30
Criterion 3Level III Max Points30 points
Level II Max Points
24 points
Level I Max Points
18 points
Not Present
0 points
Criterion Score
Criterion 3: Estimating Nutritional Needs for a Patient with Cerebral Palsy
●Accurately calculates Cindy’s estimated calorie and protein needs
●Justifies the amounts by explaining, on an advanced level, how cerebral palsy and wound healing influence metabolism. Uses credible sources to support ideas.
●Accurately calculates Cindy’s estimated calorie and protein needs.
●Justifies the amounts by explaining how cerebral palsy and wound healing influence metabolism, but only on a basic level. Does not support ideas with credible sources.
●Calculates Cindy’s estimated calorie and protein needs but with minor errors.
●Does not justify the amounts or explain how cerebral palsy and wound healing influence metabolism.
Does not include Cindy’s estimated calorie and protein needs. Does not explore the influences her medical diagnoses have on her nutritional needs.
Score of Criterion 3: Estimating Nutritional Needs for a Patient with Cerebral Palsy,
/ 30
Criterion 4Level III Max Points15 points
Level II Max Points
12 points
Level I Max Points
9 points
Not Present
0 points
Criterion Score
Criterion 4: Pediatric Enteral Nutrition Formula
●Recommends an appropriate tube feeding formula brand name.
●Verifies the protein source does not contain albumin from egg protein.
●Cites a credible source.
●Recommends an appropriate tube feeding formula brand name.
●Does not fully verify that the protein source does not contain albumin from egg protein.
●Does not cite a credible source.
●Identifies a tube feeding formula brand name, but it may not be ideal for Cindy’s condition.
●Does not examine the protein source within the formula.
●Does not cite a credible source.
Does not identify or recommend a specific tube feeding formula brand name. Does not examine the protein source within the formula.
Score of Criterion 4: Pediatric Enteral Nutrition Formula,
/ 15
Criterion 5Level III Max Points35 points
Level II Max Points
28 points
Level I Max Points
21 points
Not Present
0 points
Criterion Score
Criterion 5: Appendix: Pediatric Cerebral Palsy Sample Meal Plan
Provides a sample pureed-soft diet menu to meet Cindy’s needs. The sample menu and summary include seven or more areas of information: food descriptions, serving sizes, total calories, carbohydrates, fats, protein, and any applicable micronutrient totals.
Provides a sample pureed-soft diet menu to meet Cindy’s needs. The sample menu and summary include four or five areas of information: food descriptions, serving sizes, total calories, carbohydrates, fats, protein, & any applicable micronutrient totals.
Provides a sample pureed-soft diet menu for Cindy. Food list and serving sizes are included, but a summary of daily nutrient totals is not included.
Does not include a sample pureed diet. No menu details or nutrient totals are included.
Score of Criterion 5: Appendix: Pediatric Cerebral Palsy Sample Meal Plan,
/ 35
Criterion 6Level III Max Points15 points
Level II Max Points
12 points
Level I Max Points
9 points
Not Present
0 points
Criterion Score
Criterion 6: Length, APA References, and Writing Quality
● Meets or exceeds length requirements 2 or more pages (500 words), not counting sample menu.
● Cites three or more credible references.
●Uses numerous in-text citations (quotes/ paraphrases).
●APA format is followed.
●Correct grammar, sentence structure, and word usage.
● Meets length requirements of 2 pages (500 words), not counting sample menu.
● Cites two credible references.
● Uses some in-text citations (quotes/paraphrases).
● APA format is followed.
● Minor errors are present in grammar, word usage, and/ or sentence structure.
●Length is at least 1 but less than 2 pages (250–499 words).
●Uses one credible reference.
●Does not use in-text citations.
●APA formatting errors are present.
●Major errors are present in grammar, word usage, and/or sentence structure.
● Does not meet length, reference or writing quality requirements.
Score of Criterion 6: Length, APA References, and Writing Quality,
/ 15
TotalScore of Unit 8 Assignment Rubric,
/ 150
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