Question

ase Bertha is a 65 year old Caucasian female with an admission height of 5'4" and weight of 135 lb. was admitted with a severe episode of CVA. Considering that her recent CVA affected her speech, she was unable to communicate her weight and diet intake history to the admitting nurse. Within 24 hours, her attending primary care physician placed orders for a complete metabolic panel, Mechanical Soft/Cardiac Diet, speech consult, and nutrition consult. Upon completion of the speech pathology assessment, she documented that the patient is at high risk for aspiration and inappropriate for oral feeding at this During the initial nutrition assessment, the RD interviews the patient's daughter to obtain information on her weight history and adequacy of oral intake. Daughter reports that patient has a normal weight range of 130-135 lb., has a good appetite, but doesn't closely monitor her intake of sodium and refined sweets as often as she should. Furthermore, the MD and speech pathologist estimate that Bertha is expected to need nutrition support for 5 weeks while undergoing rehabilitation. tim Past Medical History: HTN, hysterectomy, Depression, GERD Medications: Prilosec, Lisinopril, Zoloft Pertinent Admission Labs Parameter BUN Creatinine Sodium Potassium Albumin Magnesium Phosphorus Glucose Lab Value 43 0.8 153 4.3 3.0 2.8 3.5 108 As the clinical nutritionist, which alternative feeding modality would you recommend and why? Would you suggest inserting a long or short-term feeding device? Which device of the chosen feeding modality (enteral or parenteral) would be appropriate for the circumstances of this patient and why? 1. 2. 3. What issues are this patient's current lab values suggesting? 4. What are her estimated calorie, protein, and fluid requirements? Please show all calculations. 5. Construct two appropriate PES statements for this case 6. 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. What classification of risk is this patient (low, moderate, high) and within how many days will you follow up on patient progress? What members of the healthcare team will you communicate with for coordination of care? Explain why What would be your Monitoring and Evaluation plan for this patient case? 8. 9.

Answer 1

Q. No. 1. Answer :

As a clinical nutritionalist, I would recommend alternative feeding methods like

* Nasogastric tube feeding,

* Total parenteral feedings,

Because patient is having cerebro vascular accident, so there is a chance to aspiration, so the nasogastric feeding may prevent the aspiration.

If not sufficient feedings and nutrition through this nasogastric tube, to maintain normal nutritional status we can plan for total parenteral nutrition therapy.

Q. No. 2. Answer :

Yes, I would suggest to insert a feeding device, that is enteral because patient is having a chance of aspiration so to prevent that we need to choose first enteral feeding tube.

Through the all of persons requirement we can supply through enteral, but in parenteral feeding we can enters nutrients into the blood only.

Q. No. 3. Answer :

* increased BUN values that is 43 mg per dl. Normal range is 14 to 23 mg per dl.

It indicates patient is having some kidney problems.

* increased sodium levels those are 153 m.mol per liter, normal range is 135 to145 m.mol per liter.

It leads to patient suffers from altered level of consciousness, fatigue, increased thirst, irritability, restlessness, dehydration.

* less albumin levels that is 3.0 g per dl. Because normal range is 3.5 to 5.5 mg per dl.

* increased magnesium levels that is 2.8 meq per liter.

Because the normal range is 1.5 to 2.5 meq per liter.

These are the problems and abnormal values are patient having in her lab reports.

Q. No. 5. Answer :

PES statements for this case is

* Inability to swallow related to lass of sensory function as evidenced by dysphagia or difficulty in swallowing.

* Impaired physical mobility related to cerebrovascular accidents as evidenced by verbalization of client.

* activity intolerance related to loss of energy or due to inadequate intake of nutritious diet as evidenced by inability to perform daily living activities.