Clinical Case Report: Fungal Esophagitis

Objective: To practice in depth analysis and application of the Nutrition Care Process
(NCP), and evidence-based practice in a complex adult case concerning critical illness
requiring nutrition support.
Candida fungi are responsible for the majority of fungal infections in humans.
Oral thrush is a common form of candida infection, often seen in patients with human
immunodeficiency virus (HIV) patients. Sometimes, a candida infection can spread to the
esophagus, and cause swallowing/ motility problems, and dilation of the esophagus. This
case patient was admitted for candida esophagitis and poor food intake following a
Nissen fundoplication surgery for chronic gastroesophageal reflux disease (GERD).
Following a regimen of antifungal medications and nutrition support, her fungal infection
improved, and she was able to return to a regular diet.
Nutritional management for candidiasis is designed to maintain calorie and
protein needs. Due to this patients poor po intake, and dysphagia, total Parenteral
nutrition was initiated to maintain her needs. This case report focused on the patients
nutritional status throughout her hospital stay. Through regular visits from the dietitian,
and review of physician notes her progress was closely monitored. The Nutrition Care
Process was utilized for regular monitoring and evaluation of her progress. This
information was compiled into a detailed report, and a subsequent slide show was
developed to present this report to fellow dietitians, preceptors, and interns.
Competencies Met: The Clinical Case Report Project meets the following
competencies from the 2012 CADE ERAS:
1.2- Apply evidence-based guidelines, systematic reviews and scientific literature
(such as the ADA Evidence Analysis Library, Cochrane Database of Systematic Reviews
and the U.S. Department of Health and Human Services, Agency for Healthcare Research
and Quality, National Guideline Clearinghouse Web sites) in the nutrition care process
and model and other areas of dietetics practice
1.4- Evaluate emerging research for application in dietetics practice
2.2- Demonstrate professional writing skills in preparing professional
communications (e.g. research manuscripts, project proposals, education materials,
policies and procedures)
2.7 Refer clients and patients to other professionals and services when needs are
beyond individual scope of practice
3.1- Perform the Nutrition Care Process (a through d below) and use standardized
nutrition language for individuals, groups and populations of differing ages and health
status, in a variety of settings
SP 3.1.a. Assess the nutritional status of individuals, groups and
populations in a variety of settings where nutrition care is or can be delivered
SP 3.1.b.Diagnose nutrition problems and create problem, etiology, signs
and symptoms (PES) statements

SP 3.1.c. Plan and implement nutrition interventions to include prioritizing

the nutrition diagnosis, formulating a nutrition prescription, establishing goals and
selecting and managing intervention
SP 3.1.d. Monitor and evaluate problems, etiologies, signs, symptoms and
the impact of interventions on the nutrition diagnosis

A supplemental Power Point presentation was developed for this

case study to present to fellow dietitians, preceptors, and interns on
site.