Question

Mr. Angelo is a 65 year-old male admitted to the hospital as level 2 trauma with 40% total body surface area (TBSA) burns after being involved in a trailer fire. He is admitted to the surgical intensive care unit for management of his burn injury.

Anthropometric Measurements:

Height: 72”       Weight 160 lbs

NFPA:

Poor skin turgor

Burns involving entire face and body

Laboratory values:

Albumin 2.1 g/dL (normal 3.5 -5 g/dL)

Prealbumin 12 mg/dL (normal: 18 -35 mg/dL)

Diet:

NPO. Will start enteral nutrition using gastrostomy tube

1.      Write one PES statement for this patient.

2.      Calculate energy needs using Mifflin St. Jeor equation. Add the physical activity factor as limited activity, and add the physiological stress factor

3.      Calculate protein needs

4.      What type of formula would be appropriate for this patient? For continuous enteral feeding, calculate the volume in ml and the goal rate

5.      At what rate would you start the formula? How do you advance it?

6.      Calculate fluid needs and determine the flush order to meet fluid needs

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Answer 1

Ans.)

1. PES statement - NPO (nothing by mouth) with EN (enteral nutrition)

2. Calculation of energy requirement - Based on the diet order, the patient should be currently receiving 60 ml/hr of impact with Glutamine and 25 ml/hr of Propofol, which add up to a maximum of 2,220 kcal/day if he started receiving EN within the first hour of hospitalization.

3. Calculation of protein requirement-. Impact with Glutamine is 24% protein, so patient would receive a maximum of 93.6 g of protein in the first day of hospitalization.

4. Appropriate formula for this patient is Jevity (1.2 Cal) @ 70 ml/hr. The enteral feeding recommendation for a burn patient will need to accommodate the special metabolic requirements of this stressed state.

6. Calculation of fluid requirement – On the basis of the fluid order, at first the patient was administrated fluid recovery using Lactated Ringer’s at 610 ml/hr for the first eight hours and then reduced to 305 ml/hr for the next 16 hours. Though, patient had a total fluid intake of 16,425 ml and an output of 1,696 ml (1,295 ml from urine, which is approximately 18 ml/hr). On the basis of Parkland formula, the patient needs 11.4 L of fluid within the first 24 hours.