Question

4. If Ms. Brown were to receive bolus foedings 5 times a day, how many milliliters of formula would she need at each feeding? 5. Which tube feeding delivery method would you suggest for Ms. Brown and why? Parenteral Nutrition Support Activities Case Study 21.1: Bus Driver Requiring Total Parenteral Nutrition Support Darius Foster is a 31-year-old bus driver admitted to the hospital after a serious motor vehicle accident. He has severe intemal injuries, including a punctured spleen and broken ribs, Two days after admission he develops paralytic ileus intestinal paralysis). His health care team determines that he will need total parenteral nutrition (TPN) support for an extended period of time. A review of his medical record reveals he has type 2 diabetes for which he takes oral medications. His blood glucose on admission is 340. He is 70 inches tall and weighs 180 pounds. The nutrition support team decides to start him on a total nutrient admixture (TNA). 1. Describe the conditions that make Darius a candidate for parenteral nutrition 2. How does Darius's diabetes influence the blend of parenteral formula used for his nutrition support? Explain other strategies to help manage his hyperglycemia when nutrition support is initiated. 3. Based on his weight, estimate Darius's fluid needs rounded to the nearest 5 milliliters 4. Based on the expected stress response to his injuries and his medical history, describe how you would monitor his nutritional status daily and weekly while he is on nutrition support. MacBook Air

Answer 1

1. The conditions that make Darius a candidate for parenteral nutrition are :-

- paralystic ilieus

- to recover fast

- for essential nutrients and electrolyte supply to the body because he can't take by mouth due to accident

- for his glucose management

2. Management of hyperglycemia in parenteral nutrition :-

- One hour monitoring of bloos glucose

- providing TPN as per the prescribed dose

- holding the TPN when his blood glucose reaches high according to physician order

- insulin therapy

3. Weight of the patients is 180 lbs = 180×0.45kg = 81kg

= For > 20 kg = 1500 mL + [weight (kg) x 20 ml/kg/day]

= 3120ml

4. Monitoring of nutritional status :-

- Monitoring of weight daily

- Urine out monitoring daily

- Monitoring of lab values and ABG values for electrolytes

- Assessment of signs and symptoms related to nutrient deficiency like edema etc