She was in the ICU for 5 days following surgery related to difficulty coming off intubation. During her time in the ICU she was receiving IV fluids, but no enteral or parenteral nutrition. She is now awake and breathing on her own, but having difficulty swallowing due to her prolonged intubation. She is currently NPO (nothing per oral). Her physician recently placed a nasogastric tube and is ready to start enteral feedings. You obtain the following information from her chart:
Medical history: Diagnosis of Crohn’s disease 5 years prior to surgery. History of weight loss and restrictive eating patterns related to GI distress. Other diagnoses include acid reflux, history of stomach ulcers, and depression.
Anthropometrics: Current Weight 132 lbs. Usual Weight (1 year ago): 150 lbs. Height 67”
Biochemical: BUN 23 mg/dl Cr 1.2 mg/dL Albumin 3.0 g/dL Glucose 98 mg/dL Potassium 4.2 mEq/L Sodium 136 mEq/L
Nutrition focused physical assessment: Mild muscle wasting to temporalis, interosseous of hands, and subclavius. Brittle nails and hair.
During your interview Kelly states that she is having some abdominal pain from her recent surgery and overall fatigue. She reports poor appetite and mild nausea. She is currently receiving pain medication and anti-nausea medication. She tells you she was having poor appetite and constant diarrhea for 2-3 months prior to her surgery. He physician told her that her symptoms will be much improved with her recent bowel resection, but she is nervous about starting to eat again. She reports the nasogastric tube isn’t causing any pain, but it is uncomfortable.
Answer the following questions related to this case:
1.Calculate the following needs based on Kelly’s current state:
a.Estimated energy requirements (state formula and show work)
b.Estimated protein requirements (state formula and provide range)
c.Estimated fluid needs
2.Based on the information provided, select an appropriate tube feeding formula from the formulary sheet.
3.Calculate the total goal volume of tube feeding that will be administering over 24 hours
4.Based on the information provided, which administration method is best for this patient? (continuous feedings, intermittent feedings, or bolus feedings)
5.Based on your answer to question 4, what volume of feeding will you administer per hour or per bolus to meet your stated goal volume.
6.Will the volume/rate of formula meet the patient’s protein needs?
7.Will the volume/rate of formula meet the patient’s fluid needs?
8.How would you ensure the fluid needs are met?
9.Write an enteral nutrition order that would go in the intervention section of the nutrition care process