A2

Therapeutic-diet nonadherence

Skilled nutritional assessment found nonadherence to the prescribed low-sodium diet — a diet recall revealed frequent high-sodium processed foods — with a 3-lb weight gain and increased ankle edema (volume interpreted in the cardiovascular assessment). Findings indicate diet nonadherence contributing to fluid retention. Provider notified at 12:00 with the dietary findings and the weight and edema change; order received to reinforce the diet and apply the volume plan. Skilled teaching provided on sodium label reading, hidden sodium, and the link to fluid retention; teach-back accurate. Reassessment of intake, weight, and edema planned next visit. (Volume interpretation in the Cardiovascular reference and CHF overlay.)

A3

Enteral intolerance / elevated residual

Skilled nutritional assessment found enteral intolerance — an elevated gastric residual above the ordered parameter with nausea and abdominal distension during the feeding. Findings indicate intolerance of the current regimen. The feeding was held per protocol and the head of the bed elevated; provider notified at 10:40 with the residual volume and the symptoms. Order received to hold and recheck the residual, reduce the rate, and reassess tolerance. The site was intact; the caregiver was re-educated on positioning and the hold parameters; return demonstration accurate. Reassessment of tolerance and residual planned per the order.

A4

Reduced intake with early satiety

Skilled nutritional assessment found reduced intake to approximately 40% of meals with early satiety and mild nausea over the past week; weight is down 2 lb and trending down. Findings indicate declining intake placing the patient at nutritional risk. Provider notified at 13:10 with the intake estimate, the weight trend, and the GI symptoms; order received to evaluate the nausea, start a supplement, and consider an antiemetic. Skilled teaching provided on small frequent meals, fortification, and managing early satiety; teach-back accurate. Reassessment of intake, weight, and symptoms planned next visit.

A5

Food insecurity limiting intake

Skilled nutritional assessment found reduced intake attributable to a food-access barrier — the patient reports limited food in the home because of cost and difficulty shopping — with a modest weight decline on the trend. Findings indicate intake limited by a social barrier. Provider notified at 11:50 of the barrier and the weight trend; the agency initiated coordination with social work for food resources and a community program. Skilled teaching provided on maximizing the nutritional value of available foods; teach-back accurate. Reassessment of intake and weight planned next visit after resources are in place.

A6

New dysphagia limiting safe intake

Skilled nutritional assessment found new difficulty swallowing with coughing and a wet-sounding voice during the meal and reduced intake as a result. Findings indicate new dysphagia limiting safe intake and posing an aspiration risk. The current texture was held and the patient kept upright; provider notified at 09:55 with the swallowing findings and the intake change; order received to evaluate swallowing and modify the diet texture, with instruction to activate emergency response for choking. Safe-swallowing precautions reviewed with the caregiver; teach-back accurate. Evaluation coordinated and reassessment planned. (Swallowing mechanics in the Taste / Swallowing reference.)