I am a student dietitian and my case study is on a young lady with cerebral palsy. Her recent requirements were estimated due to it being too stressful and difficult to weigh, and no weight records. She has a NG feed at present and is hoping for a PEG if this is appropriate. I was wondering if anyone had any references to cerebral palsy and estimating requirements, feeds for disabled pts or any futher info in this area
thank you
Re: cerebral palsy
ciara
15-08-2007 04:44
There are no 'special feeds' for disabled clients, although nutritional requirements in this client group is an area that is poorly researched.
From my experience, actually trying to meet the requirements of CP patients practically via the oral route is difficult (due to other problems such as positioning, dysphagia, etc) hence the need for supplementary support.
The PENG pocket guide should be a starting point to estimate requirements, however these are not gold-standard and the evidence on which they are based should be related to your individual client.
As with any patient, you should have clear aims, objectives and rationales for your treatment plan, and timely monitoring to ensure that you are on course to meet these / review as necessary.
Hope that helps?!
Re: cerebral palsy
emerson
15-08-2007 04:45
Thank you so much for your help!! However I do not have a weight or height so where should I go from there? My supervisor has estimated with the Drs assistance without these factors, I know he is correct but i need evidence for this choice? I am unsure where to find it.
Thanks you
Re: cerebral palsy
danica
15-08-2007 04:48
Have you considered other methods of assessment such as subjective global assessment, mid-arm circumference, triceps skinfold, knee height, etc?
You may not get great results, but at least you have tried and this will make for a good discussion point in the difficulties of assessing such patients...
Have you looked in the PENG handbook, this describes all these methods?
You could also do a diet history to assess what you think the patient was managing orally, and if he / she was losing weight on this then start by adding 300 - 500 kcals extra to promote gain, and REVIEW!
This is a good discussion for all the students here... it gets you thinking about the real work of dietitians... i.e. not evry patient fits the rules that you have been taught, you need to be practical in putting the science into everyday life!
Re: cerebral palsy
ava
15-08-2007 04:50
Hi,
The course has been updated (and improved) since I was
a first year but we had about 20 hours of lectures. But you can be stuck on site for longer than that because you may have a couple of hours in the morning and then a couple late afternoon. So realistically it's full time except for maybe Wednesday afternoon.
There is a lot of coursework so you have to be quite self disciplined to work in any gaps and to keep on top of it.
The first year has the most hours and it drops quite a lot in the third and fourth year - but the placements have quite a high workload.
But every year there are students who manage whilst bringing up children.
Re: cerebral palsy
estralla
15-08-2007 04:52
Glad to see that there is lots of discussion going on!!
Re: cerebral palsy
keane
15-08-2007 04:53
Hey just a note of thanks for your help. Just finished a fabulous b placement and good feedback for my case study. Wish it was marked now!! Just shows how this site can help
Re: cerebral palsy
joyride
15-08-2007 04:57
So what did u actually do to assess / review this patient?!
