Textbook Problem

Just because she lives at Lenoir Manor, a continuing-care retirement facility, Laura, a petite (4 ft 8 in., 97 lb) widow of the local college dean, does not consider herself as old. She is 87. She has had no major nutritional or health problems and her appetite is good. She had been a good cook and entertained graciously, but in the residential care facility, meals are prepared for her. Because she has had slight fluid retention over the past year, she no longer adds salt to her meals. She tells Bridget Doyle, her nutritionist, that yes, occasionally she does not like her meals and misses cooking for herself.

One Monday morning, Laura is found in bed with her left side paralyzed. The diagnosis is a right-sided stroke, resulting in three weeks of hospitalization. Back at the skilled-care wing of Lenoir, Laura needs a nasogastric tube for feeding. She is alert and knows people but is limited in speech. Overnight, Laura’s care has changed from an individual needing routine nutritional monitoring to someone with many interrelated problems:

• Inability to communicate her overall medical and nutritional concerns clearly
• Weight loss of 9 lb during the three-week hospital stay
• Intense dislike of the nasal tube, as demonstrated by repeated attempts to pull it out, leading to restraint of her hands

Monitoring and Evaluation

How could Bridget ensure that Laura’s nutritional needs are met?