a.The total parental nutrition is expensive. As the patient has already undergone a surgery in the colon ,the absorption of certain nutrients when given via tube feeding will be interrupted and not absorbed.Further this can increase the workload of the intestine. Normal function of the intestine to return can take some time.In order to prevent the deficiency, malnutrition TPN are more effective because the nutrients can reach the blood strain.Moreover patient is starving or kept NPO for more than seven days will be administered only TPN first.
b.Cebtral line will be the first and priority when trying to administer TPN.The concentration of the solution has a direct impact the blood flow from where it flows. In case a peripheral line is selected there is risk for thrombophlebitis and damage to blood vessels. The median cubital vein can be given the second line of preference beause of its size and diameter compared to other blood vessels to administer TPN.
c..As the patient is more hungry, it means the patient needs calorie to balance it so administration of D30A10 can lead to faster absorption of glucose and calorie production.
d.Tte maximum length of duration for administration of TPN is about 2 weeks or 15 days after surgery.It will not be required more in case when patients are stable and has no malnutrition.It can
2. Mark is a 30yo businessman who was diagnosed with Crohn’s dz over ten years ago;...
Mark is a 30yo businessman who was diagnosed with Crohn’s dz over ten years ago; otherwise, he’s a healthy guy. He’s been free of flare-ups for the past couple of years, but a recent business trip to Thailand (stress, new foods) may have been the trigger for his most recent flare-up, a particularly bad one which put him in your hospital and ultimately resulted in resectioning of his jejunum. Mark was NPO for 3d prior to surgery and 9d post-op;...
Mrs. Reese is a 36-year-old woman who was diagnosed with Crohn’s disease 2 years ago. She was recently admitted to the hospital with an exacerbation of her Crohn’s disease. She was severely malnourished and was found to have complete bowel obstruction with multiple adhesions. She is 5’ 4” tall and weighs 108 pounds, with a usual weight of 122 lbs. She is scheduled for surgery, and undergoes a small bowel resection to remove the diseased bowel and create a temporary...
Uncle Mark, the family’s favorite uncle, choked on a turkey bone during the Thanksgiving Dinner. He was able to get the bone up but started vomiting blood and he was taken to the hospital. During his hospitalization, his niece Kim and nephew Mike came to see him. Mike stated, “Uncle Mark has man-boobs! And a really weird tan.” Kim said, “He looks orange to me, and his beer belly has gotten really big. He has red spots all over his...
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Case 3. A married Latino man, 25 years old, is talking to a counselor about trouble with his mother-in-law: “The way I see it, she is really trying to destroy our marriage. She’s so conniving. And she’s very clever. It’s hard to catch her in what she’s doing. You know, it’s rather subtle. Well, I’ve had it! If she’s trying to destroy our marriage, she’s getting pretty close to achieving her goal.” Empathic response. Question probe. Statement probe. How might...
Patient: Mr. Rogers. Gender: Male Age: 79 4/4/2040 Setting: Medical Surgical Unit in Hospital. Pre-existing Conditions: Diabetic Type II, Chronic Leg Ulcers, Peripheral Vascular Disease, Stroke, and Aphasia. Mr. Rogers is 79-year old male that came into the ER with complaints of Right lower leg pain. He was found to have cellulitis of his right calf. Patient states, “I know my leg wounds have been draining a lot lately, but for the last 2 days my leg feels inflamed and...
In 2007 the Star Ledger newspaper told of a young man (unnamed for his own protection) in Newark who witnessed a murder while walking home one day. It was a territorial drug dispute that didn’t even involve the murder victim who was just in the wrong place at the wrong time. The man who witnessed the murder recognized a couple of the assailants who also recognized him. He ran and wasn’t found until police discovered him during investigations. He knew...
Mr. Bennet is 60 years old. He teaches grade 5 and loves working with his students. He was diagnosed with MS at 30 years old, after many years of having symptoms. He has primary progressive MS. He enjoys teaching and hopes he will be able to continue to work in his chosen career until retirement. He is also married and has 4 young grandchildren. He is a hands-on Grandpa. He enjoys reading to his grandchildren and helping them with their...
Google CEO Sundar Pichai, One of the World's Most Powerful Business Leaders A few years ago Sundar Pichai became CEO of Google, the major division of Alphabet. He is an unassuming man of humble begin-nings, growing up with his parents and a brother in a two-room apartment in the Chennai, India. Always brilliant, as shown in his ability to memorize hundreds of numbers dialed on a rotary phone, he was a reserved but fiercely competitive student. Pichai has been described...
Jack Adam’s mind wandered as he sat outside Bill Squire’s office awaiting his yearly performance review… [Jack thinking.] Well, it’s 8:25. Five more minutes to go. Fifteen years with the company, and this new district manager, Squire, couldn’t even call and request this meeting personally. These annual performance appraisals are tough enough, and here I’ve got a bad sales record for the past 12 months. Surely he’ll be able to understand that the sales decreases were a result of the...