Question

its nutrition related, only answer if you really know it. thanks

Shannon is a 29 year old female currently intubated and sedated in the ICU due to domestic abuse. Today is hospital day #3. She had surgery after being admitted from the emergency department to repair her small bowel, colon, liver and spleen due to multiple abdominal stab wounds. Her abdomen is currently firm and distended with negative bowel sounds. She has a nasogastric tube in place which has drained 1800 mL out in the past 24 hours. A triple lumen has been inserted into the superior vena cava. Patient reportedly had been having some health issues prior to admission. She is employed as a lab tech at a local university and told her Mom that she had lost 10 lbs. in the last 2 months due to work-related stress. She was having lots of abdominal cramps and had really lost her appetite. She has two children aged 4 and 6. IV fluids are running at 100 mL/hr with D5W and ½ normal saline with 20 mEq/d of KCL. A nutrition support consult has been ordered to start parenteral nutrition Ht:5'7"Current Wt: 125 lbs. (57 kg) Usual Wt: 130 lbs. (2 months ago) Nutrition-focused physical exam: patient appears thin but no overt signs of nutritional deficiencies; abdomen is firm and distended with negative bowel sounds Current medications: meds for sedation and pain control; antibiotics to decrease infectious complications Labs: Sodium: 135 (135-145) Potassium: 4.0 (3.5-5.5) Chloride: 99 (99-112) Bicarb: 26 (22-29) Glucose: 91 (65-99) BUN: 10 (8-24) Creatinine: 0.8 (0.6-1.1) Albumin: 2.8 (3.5-5.5) WBC: 1(4) Hemoglobin: 12 (11-15.8) Vital Signs: Temp: 00 MAP: 59, 60, 59, 58, 57 UOs for the past 2 days hospital day #1: 32402500 mL hospital day #2: 2800/2300 ml. Complete a nutrition assessment. Address whether parenteral nutrition is indicated or not: Create 2 PES statements: P: E: S: P:

PES is nutrition related: P stands for problem, E is for Etiology and S for Signs/Symptoms.

and be sure to answer the top question too.

Thanks

Answer 1

NUTRITIONAL ASSESSMENT: Nutritional assessment is the complete assessment of both subjective and objective data of nutritional status of an individual.

PURPOSES:

• to identify the nutritional status
• to identify the risk of malnutrition
• to prepare nutritional plans
• to evaluate the implemented nutritional plans

The nutritional assessment can be done by the following methods.They are:

1. Anthropometric measurements
2. Biochemical or laboratory methods
3. Clinical methods
4. Dietary evaluation methods

=>Anthropometric measurements

Anthropometric measurements are the objective assessment of the body growth.It helps us to compare the findings with the recommended measurements and can evaluate the nutritional status.

It can be measured by the following methods:

-height

-weight

-mid arm circumference

-hip/waist ratio

-body mass index

-skin fold thickness

• Measuring the height:

The person stands on a stadiometer with a movable head piece with bare foot and the heel and occipital protrubarence should touch the stadiometer and the height can be measured.

Mrs shannon's height is 5'7" that is 1.7 meters.

• Measuring the weight:

Weight can be measured by regularly used electronic weighing machines.Weight can be measured with light clothes and without shoes.

Mrs shannon's weight is 125 lbs that is 57 kgs

The international standard for the assessment of an individuals nutritional status is BODY MASS INDEX.

It can be calculated by using the following formula=weight(kg)/height(m²)

calculation of BMI for Mrs Shannon is = 57/(1.7)²

  =57/2.89

=19.73

Mrs Shannon's BMI =19.73

BMI	NUTRITIONAL STATUS
Below 18.5	Under weight
18.5-24.9	Normal weight
25-29.9	Over weight
30 and above	Obesity

So Mrs. Shannon is maintaining normal BMI

• Waist hip ratio:

Waist circumference can be measured at the level of umbilicus

Hip circumference can be measured at the greatest level of the hip circumference

waist hip ratio can be calculated be using the following formula

WAIST HIP RATIO: waist circumference/hip circumference

If the value is more than 0.8 then it will be considered as obesity.

• Skin fold thickness:

This measurement helps to identify the fat stores in the body.

skin fold calipers are used to assess the skin fold thickness.

• Mid upper arm circumference:

Mark witha pen in between olecranon process and acronium and wrap the tape around the marked point.

The normal range is 23-25.5cm

=>Biochemical or labarotary levels:

Laboratory values are very important to identify the risk as well as already existing nutritional deficiencies.

The following values should be monitored:

INDICATOR	NORMAL VALUE	CLIENT VALUE
Plasma glucose level	60-120 mg/dl	91mg/dl
Haemoglobin	12-16 mg/dl	12mg/dl
Haematocrit	36-46%	-
Cholesterol	120-200 mg/dl	-
Serum protein	6-8 gm/dl	-
Serum albumin	3.5-5.5 gm/dl	2.8gm/dl
Pre albumin	15-25 mg/dl	-
C-reactive protein	<0.1mg/dl	-

• Clinical assessment:

Clinical assessment includes the data regarding the illnesses of the client including past and present.It involves the complete details of the illness such as type of illness,treatment etc.

Clinical assessment helps to identify the nutritional needs based on the treatment.

According to the history collected Mrs.Shannon was having some illness which is not significant.

• Dietary assessment:

Dietary assessment can be done by the following methods:

-24 hour dietary recall

-dietary history

-food dairy technique

-observed food consumption

=>24 hour dietary recall

In this method the client will be asked to recall the foods or drinks that she have taken on the whole day.

=>Dietary history:

It includes overall eating,frequency of intake,24 hour recall.

Mrs.shannon having the complaint of loss of appetite,because of which she lost her weight.

over all nutritional assessment says that the client is adequately nourished but lost weight because work stress.

PARENTERAL NUTRITION:

Parenteral nutrition is the intravenous administration of the major nutrients such as protein,carbohydrates,fats and minor nutrients such as vitamin and minerals where the person cannot be able to eat and digest the food either by oral intake or tube feeding.

Indications:

-bowel obstruction

-short bowel syndrome

-prolonged bowel rest

-severe malnutrition

-cancers

Mrs Shannon is having damage to small bowel,colon,liver and spleen and also having multiple stab wounds.Currently abdomen is distended and bowel sounds are absent.

So Mrs. Shannon can be started with parenteral nutrition to improve the nutritional status

PES STATEMENT:

Statement 1:

P-Imbalanced nutrition

E-Injury of bowel

S-Loss of weight

Statement 2:

P-Activity intolerence

E-multiple injuries

S-not able to continue daily routines