Question

Case 2 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 Magnesiunm Phosphorus Glucose Lab Value 30 0.6 149 3.3 2.2 2.1 3.0 83 . As the clinical nutritionist, which alternative feeding modality would you recommend and why? 2. 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? 3. What issues are this patient's current lab values suggesting? 4. What is his percent weight change and what category of risk does it indicate? 5. What are his estimated calorie, protein, and fluid requirements? Please show all calculations. 6. Construct two appropriate PES statements for this case 7. *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 8. 9. 10. 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- 1.2 kcal per ml, 18.5% kcal from protein, 79% free water. Protein supplement for tube feed if needed: Prosource Liquid Protein per 1 oz. (30 ml) tube 100 kcal and 15 grams of protein

Answer 1

1. Gastroenteric tube feeding and jejunostomy tube feeding are the alternative feeding modality for this patient which helps to manage gut dysfunction. The food is directly administered into the stomach which minimizes the risk of infection.

2. Enteral feeding is appropriate for this patient which has fewer complications compared to parenteral nutrition. Gastrostomy tube with internal fixation device is used tor long term feeding for this patient.

3. His lab values suggest elevated BUN and low albumin level. This shows the patient has impaired kidney function and dehydration.

4. Decrease in weight = original weight - current weight

= 181 - 175

= 6lbs

Percent of change in weight = 6 / 181 X 100

= 3.31%

He has a low-risk category of weight change.