Pt is a 25 year-old man admitted to the ER secondary to multiple gunshot wounds to the left flank, right buttock, and right thigh. He was taken to the operating room for an exploratory laparotomy, extensive lysis of adhesions, small bowel resection, repair of the third portion of the duodenum, and repair of the duodenal wall. Pt is transferred to ICU. TPN will be initiated rather than enteral feedings due to the patient’s hemodynamic instability. A jejunostomy tube is placed. The RD is consulted for an initial assessment.
The patient was intubated and sedated. Some diet history was given by his mother. On hospital day 10 his WBC count was elevated and he presented with a fever. Abdominal distention was noted and he was taken back to the operating room. He had an abscess in the right upper quadrant area which was drained. Day 15, enteral feeding was initiated.
Answer question 1 to 11
Questions:
- Which weight would you use to determine his calorie needs and why?
- Determine the patient’s initial calorie and protein requirements. What is your recommendation for grams of protein, dextrose and lipids?
- What is the reason why his albumin and prealbumin levels are lower than normal? Before admission, he was well-nourished.
- Which type of enteral formula would be appropriate to recommend for this patient?
- The patients prealbumin dropped from 9.8- 8.0 in one week. The TPN formula was providing 2.0 g/kg of body weight per day. Should you adjust the protein goal for the enteral feeding? What other lab test can be done to help you determine if more protein is justified?
- What is another way to determine if your nutrition prescription for enteral or parenteral nutrition is meeting his needs?
- Recommend a goal rate for the enteral feeding. Include total calories, grams of CHO, protein, and fat.
- Would you recommend continuous, intermittent, or bolus feedings? When should the TPN be discontinued?
- The patient was receiving continuous jejunal tube feeding at a rate of 50 mL/hour, gastric residuals were noted to be 100 mL/hour. Is this an indication of an intolerance to the feeding?
- Identify an appropriate nutrition diagnosis for this patient, write two PES statements
- What are some nutrition-related outcomes you would like to see for this patient?