Question

Ricardo is a 36 year old African American male who had a recent colonoscopy due to paternal history of colon cancer in his immediate family. He was re-admitted into the surgical ICU of the hospital for a medical error made during his colonoscopy. During the procedure, the gastroenterologist accidently punctured his colon. This left him very septic with intractable nausea and vomiting. At 5'11", his pre-colonoscopy admission weight was 181 lb. and was re- admitted into the surgical ICU two days later weighing 175 lb. The medical team estimates a recovery period of NPO for 18 days with very close monitoring. Since he is at high nutrition risk due to sepsis, his feeding plan will be critical to optimal recovery Past Medical History: Inguinal Hernia Repair Medications: N/A Pertinent Re-admission Labs: Parameter BUN Creatinine Sodium Potassium Albumin Lab Value 30 0.6 149 3.3 2.2 2.1 3.0 83 Magnesiumm Phosphorus Glucose I. What are his estimated calorie, protein, and fluid requirements? Please show al calculations 2. Construct two appropriate PES statements for this case. 3. *Intervention: What feeding rate/hour would you recommend daily? If this patient is on enteral support, how many ml of free water would you recommend? If this patient is on parenteral support, what is this patient's GIR (Glucose Infusion Rate) and what would be the appropriate dose of dextrose, AA, and lipid content? Please show all calculations 4. What classification of risk is this patient (low, moderate, high) and within how many 5. 6. days will you follow up on patient ptbgress? What members of the healthcare team will you communicate with for coordination of are? Explain why What would be your Monitoring and Evaluation plan for this patient case? "If the feeding modality is enteral, use this formula for your calculations: Jevity 1.2 18.5% kcal from protein, 29% free water Protein supplement for tube feed if needed: Prosource Liquid Protein 100 kcal and 15 grams of protein 1.2 kcal per ml,

Answer 1

1. a) Calorie requirement of the patient is calculated by the following formula :

Step 1: Find your body weight in kilograms (if you live in the US, just divide your weight in pounds by 2.2 to get your weight in kilograms).

Step 2: Multiply your weight in kilograms by 0.9 if you are a woman or 1.0 if you are a man.

Step 3: Multiply by 24

Step 4: Multiply by your “Lean Factor”

Step 5: Multiply by Activity Modifier

1. Present weight of the patient is 175lbs = 175*0.45 = 78.75 kg

2. Multiplied by 1(for man) = 78.75kg

3. Multiply by 24 = 78.75*24 = 1890

4. Multiply by lean factor means body fat percentage  (lean factor for this patient is 1 ) = 1890*1 =1890

5. Multiply by activity modifier (activity modifier for this patient is very light = 1.3 ) = 1890*1.3 = 2457 calories/ day .

The calorie requirement for this patient is 2457 calories / day

b) The average adult needs a minimum of 0.8 grams of protein per kilogram of body weight per day. Protein requirement for this patient is 0.8* 78.75 = 63grams of protein / day

c) For patients with weight more than 20 kg ,daily fluid requirement is 1500 ml+ 20ml/kg/day

Fluid requirement for this patient is = 1500ml + 20ml*78.75kg/day

= 3075ml

2. The fullform of PES is problem ,etiology and sign and symptomsa.

a. Sepsis related to accidental rupture of colon during colonoscopy as evidenced by nausea ,vomiting .

b. Inadequate nutrition related to NPO status as evidenced by decrease in albumin levels .

3. If a person requires 1,500 kcal from tube feed, they will need 4 cans or 1,000 mL of a 2.0 kcal/mL formula. This patient requires 2457 calories /day for that he would require =1000ml / 1500kcal *2457 = 1638 ml/ day so, 1638/ 24 hour = 68.25ml/hour.

4. The classification of risk to which the patient belongs is high risk and will follow up the patient the days he is admitted and extra 2 weeks to see his progress .