Question

           

PJ is a 50 yo woman admitted to the ICU for acute respiratory failure following abdominal resection for colon cancer. She is 64 inches tall, and weighs 115 lbs. Prior to admission, she had lost 10 pounds over the past month. Her oral intake prior to admission was poor for at least two weeks per her caregivers. Physical exam reveals moderate muscle wasting to her temples and clavicles, and moderate bilateral edema to her legs. She is currently NPO due to ventilator status.   

Using the AND/ASPEN consensus statement, does she meet criteria for diagnosis of malnutrition? If so, what degree of malnutrition would you rank her?

Assuming an NG tube was placed for nutrition support, determine the patient’s energy and protein needs and write a TF order for this patient.

On day 3, the patient’s gastric residual volumes (GRV) are 150 mL, 200 mL and 125 mL on three separate occasions. The nurse tells you that the feedings have been stopped due to high GRV.

Was this an appropriate decision? Why or why not? What does the evidence say about using GRV to make decisions about enteral feeding in critical care?

On day 5, scans reveal an abdominal obstruction and enteral feedings are discontinued. The nutrition support team determines that the patient should receive 1.5 g protein/kg body weight/d and 30 total kcal/kg/d with 20% to 30% of total calories as lipid. Diprivan (propofol) is infusing at 10 mL/hr 24 hours.

Calculate the grams of CHO, Protein, Lipid, and total volume to be provided. Does your recommended PN meet the safety guidelines that we discussed in class (g dextrose/kg/d, mg dextrose/kg/minute, fluid needs, g fat/kg/d)

Answer 1

1. Malnutrition is most simply defined as any nutrition imbalance. Consensus statement is used to identify a standardized set of malnutrition in routine clinical practice. In adult undernutrition patients, who lack adequate calories, proteins and other nutrients consensus statement works on adequate tissue maintanence and repair undernutrition. Ofcourse yes, ASPEN (American Society for Parenteral and Enteral NUtrition) criteria for malnutrition helps her to gain weight as requires.

Patient with undernutrition to a degree may interrupt a) immunity b) wound healing and c) muscle strength. The energy andt protein intake needed for the patients is rely on the nutritionist advice. If no advice is given 30ml/kg/day of standard 1 kcal/ml feed is required.

Ofcourse yes, the decision made by the nurse is appropriate to the situation. It is necessary to withhold the feedings of a patient if the gastric residual volume is above 100ml. This means, the patient is not tolerating the feeding.