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    Imagine that you are a clinical nutrition assistant working at a local hospital under the supervision of a Registered Dietitian (RD). Overnight, a 74-year-old male patient was admitted to the hospital and needs to be fully assessed for any nutritional risks (in accordance with hospital/medical nutrition care laws). The hospitals initial nutritional screening protocol identified that the patient may be at nutrition risk, due to a high risk admitting diagnosis. The admitting physician suspects that the patient has suffered a heart attack; however the full cardiac consult results are not yet showing in the computer. Furthermore, the patient has recently moved here to the U.S. from a foreign country within the past year so that his daughter can help care for him due to his declining health. The entire family speaks very little English. The patients cultural background is significant because the culture may not place much influence on western-style healthcare practices. The patients expression of his culture needs to be examined further. The nurses notes reveal that the daughter does not know how much her father weighs, but she suspects that he has gained weight since her mother passed away a year ago.

    Your assignment from the supervising RD is to examine the patients complete cultural, social, medical, and nutritional background so that the next steps of the Nutrition Care Process can be instituted. Upon your initial investigation within the hospitals electronic medical records system, you notice that there is no height or weight listed for the patient. The diet order reads: NPO (nothing by mouth) and they are awaiting more lab results for various tests related to hydration and kidney function. His cardiac enzyme lab work indicates that he suffered a Myocardial Infarction (MI). The MD notes confirm a heart attack diagnosis and the MD also noted that the patient appears to be morbidly obese. His medications include: a blood pressure medication, a diuretic, and a cholesterol-lowering drug.

    1.    The patient and daughter are unaware of the patients current height and weight. His hospital bed unfortunately does not have a built-in weight scale. The patient is unable to stand upright due to his medical condition. Therefore, list and describe one alternative way to estimate height (stature) and one alternative way to estimate a persons weight. You may use the e-books, key terms, and internet resources provided or you may research this further to find additional ways to measure height and weight.  .. (look up one way to estimate height + one way to estimate weight.describe how the measurement is taken or any other associated facts with the method- like accuracy, where is came from, when it is most often used etc)

    2.    Based on your nutritional assessment and evaluation Do you feel that the patient will comply with the MD suggesting a strict very low calorie (10001200 calories), low fat, low cholesterol and low salt diet? How would you address the nutritional needs of the patient while honoring any personal preferences?      (why would the patient comply? OR  Why wouldnt he.back up your response.  How can the nutritional needs be addressed while honoring the patients cultural background/personal preferences? )

    3.    Choose a specific ethnic/cultural background (Asian, Middle-Eastern, Hispanic etc). How can you use your knowledge of the patients background to instill motivation and the desire to improve his health by eating a healthy diet? Do you think that he should be placed on the exact 10001200 calorie Cardiac restrictions diet that the Physician is recommending? Justify your answer.  ..    (how can you use what you know about the patients culture/religion etc to increase the chances of the patient following your advice for his diet?)

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