Question

Case 1 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 time. 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. Past Medical History: HTN, hysterectomy, Depression, GERD Medications: Prilosec, Lisinopril, Zoloft Pertinent Admission Labs Parameter BUN Creatinine Sodium Potassiunm Albumin Magnesium Lab Value 43 0.8 153 3.0 2.8 3.5 108 Phosphorus Glucose recommend and why hich alternative feeding modality would you ld 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 iwou and why? hat issues are this patient's current lab values suggestin hat are her estimated calorie 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? 7. 8. 9.

I need answers for question 6,7,8, and 9

Answer 1

Q. No. 7 answer :

The classification of risk of the patient is " high risk "

Because, patient is having CVA episodes and GERD, hypertension, and also some of the lab values are abnormal like increased blood urea nitrogen levels,  low albumin levels, high or increased magnesium levels, increased sodium levels ect.

These are all indicates patient is having risk of renal failure.

Up to recovery we can follow up the client may be 2 to 3 was.

Q. No. 8 answer :

I will coordinate health care team members like nephrologist for kidney dysfunctions, neurologist for cerebro vascular accident, and cardiologist for hypertension, nutritionalist for nutrientional screening and provide correct nutrients, speech therapist and physiotherapist and general physicians ect. So we need to coordinate with all these members to provide comprehensive care and early recovery of client.

Q. No. 9. Answer :

Monitoring and evaluation plan for this patient includes :

* vital signs monitoring,

* daily checking of weight,

* maintainance of input and out put chart,

* provide comfortable position while feeding.

* daily giving speech therapy and evaluate the speech levels of client.

* provide supportive therapy.

* maintainance of records and reports.

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