Question

Manuel Costa a 33-year-old male with a large burn from 1 day ago, involving 55% of his total body surface area (TBSA). After admission to the emergency department, he was stabilized and transferred to the intensive care unit (ICU). He has a central venous catheter and a nasogastric tube (NGT). Social hx: lawyer lives at home with wife and 2 small children Ht: 5’8” CBW: 178# CBW (3 days after admission) BMI 27 BP: 170/90 Temp. 101 F, Heart rate 101 PMHx: none NFPF: patient appears slightly edematous from fluid resuscitation. Otherwise appears WDWN. No apparent signs of muscle or fat wasting. Disease severity scores: APACHE II: 20 SOFA: 8 Meds: Oxandrolone, Propranolol, insulin per protocol Labs (3 days after admission): Na+ 138 (135-145 mEq/L), K+ 4.2 (3.6-5.0 mEq/L), Chloride 114 (98-110 mEq/L), BUN 21 (6-24 mg/dL), creatinine 1.0 (0.4-1.3 mg/dL), blood glucose 200 (70-139 mg/dL), Ca+ 7.0 (8.5-10.5 mEq/L), Phosphorus 2.0 (2.7-4.5 mg/dL), magnesium 1.4 (1.3-21. mEq/L), Albumin 1.5 (3.5-5.0 g/dL) Diet Rx: NPO; Nutrition Consult for enteral nutrition

Write a nutrition assessment in ADIME format

Answer 1

ADIME is a process used to ensure the best high quality nutritional care to the patients from the nutritional professionals. This also acts as a means of charting the patients progress and to have a communication between nutrionists.

It is an acronym which stands for assessment, diagnosis, intervention and monitoring / evaluation.

# Assessment : this becomes the initial step whereby the thorough history of the patient especially the nutritional history, anthropometric measurement, biochemical data, client history of health status. For the above case the height is given with BMI the biochemical data is given where chloride is increased, glucose is increased.

The APACHE II ( acute physiology and chronic health evaluation II) is were patient is in the icu as this would be done when client is admitted to icy. This again includes vitals with biochemical datas.

# Diagnosis: here based on the above assessment a nutritional problem is been identified and contributing causing factors are identified. Here the patient is hyperglycemic.

# Intervention : based on the nutrition diagnosis, objectives are set to implement to evaluate the care and effectiveness here the patient is on NPO, NG tube and orders for the enteral feeding

# Monitoring / evaluation : Progress is made on goals or the expected outcome is been tracked to ensure the nutritional problems are addressed and to follow up with proper feedback and lab reports if there is no progression seen again the reassessment step should start up.