Question

You are working as a clinical nutritionist in an in-patient/acute care setting. In reviewing the medical chart of a newly-admitted male patient, you note that this individual has a medical dx of chronic renal disease and was admitted due to uncontrolled hyperphosphatemia (6 mg/dl). In addition, you note that this individual is 65 yo, 72 in (183 cm) tall, and 190 lbs (86 kg).

1. While on patient rounds with the medical team this morning, the attending physician turns to you and inquires about estimated Kcal needs for this patient. Estimate Kcal needs based on total energy expenditure; use the factor method including a “rule of thumb” for resting metabolism and assume “restricted” physical activity since this individual is currently hospitalized.

2. Later in the day, you complete a comprehensive nutritional assessment for this newly-admitted patient. While at your desk you estimate total energy expenditure using the factor method including the Mifflin-St. Jeor equation to estimate resting metabolism and again assume “restricted” physical activity since this individual is currently hospitalized

4. In the course of treatment, this individual was scheduled for surgery to replace the arterio-venous fistula used to access the circulatory system during hemodialysis. Re-calculate total energy expenditure for this individual using the estimate from quest #2 but now accounting for a physiological stress factor for minor surgery.

Answer 1

1, Rule of thumb guidelines for estimating BMR multiply the healthy weight (IBS) by 10 for women and 11 for men

190 Ibs 190 X11

= 2090kcal needs

Rule of thumb method for estimating daily calorie expended on physical activity. Approximately 30% total calorie used.it may low as 20% in sedantary people and high as 50% in people who are very active..

2, Mifflin - st- heir equation

REE = 10 X weight(kg) +6.25 X height (cm)_ 5 X age (y)+5

10 X 86+ 6.25 X 183- 5 X65 +5

= 860+ 1,143- 325+5

TEE= 1,683

Activity level light activity ( sedantary since he is a patient with chronic renal disease 1.0-1.2..physical activity ratio for hospitalized with acute disease..multiply (PAR) by BMR..