Biochemical Data Abdomen: Distended with absent bowel sounds Laboratory test results: Sodium Potassium Chloride Carbon dioxide Glucose Blood urea nitrogen (BUN) Serum creatinine (SCr) Triglycerides (TGs) lonized calcium Phosphorus Magnesium Bilirubin (Bili) Aspartate aminotransferase (AST) Alanine aminotransferase (ALT) Alkaline phosphatase (ALP) Arterial blood gases (ABGS) pH 132 mEq/L 5 mEq/L 97 mEq/L 27 mEq/L 148 mg/dl 56 mg/dl 1.74 mg/dl 1.03 mg/dl 3 mg/dl 1.9 mg/dl 4.8 mg/dl 7260 U/L 193 U/L 7.36 98 mm Hg - Partial pressure of oxygen (pO2) Partial pressure of carbon dioxide (CO2) Bicarbonate Albumin 35 mm Hg 22 mEq/L 1.5 g/dl Note: Your pharmacy compounds with a 15% amino acid solution that intrinsically provides 0.85 mEq of acetate per gram of protein. 36-y-o woman acute variceal bleed status/ She has been intubated for airway protection and is on mechanical ventilation. She is showing signs of acute kidney injury. Pertinent past medical history: Alcohol abuse, hepatic steatosis, esophageal varices, portal hypertension, and gastrointestinal (GI) bleed. Nutrition problem: History of poor oral intake prior to admission and a current history of alcohol intake of approximately 1L (ASPEN, 2025) Doctor orders & cont medical chart Reason for consult: Initiate PN for intestinal obstruction per physician's referral (Hospital Day 2) Nutrition problem: History of poor oral intake prior to admission and a current history of alcohol intake of approximately 1 L/d Weight history: Unable to obtain Current weight: 77.2 kg (170 lb) Height: 165 cm (65 in) Weight assessment: Admission weight of 69 kg (152 lb) Physical examination: Bilateral 2+ pitting edema of ankles; generalized edema of both hands (ASPEN, 2025) Open navigator ▲ 23 tv tps://app.nearpod.com/presentation?pin=A9BQC zoom O Open navigator ▲ tv zoom Nutrition Goals Nutrition goals: 1650 kcal/d (Penn State equation); 90 g of protein (1.3 g/kg/d based on admission weight); 1380 ml/d (20 ml/kg/d) Diet: Nothing by mouth per physician Intravenous (IV) access: Triple-lumen central venous catheter (CVC), right internal jugular vein IV fluids: No current maintenance IV fluid; 0.9 normal saline (NS) infusing at 100 ml/h until 0800 hours on Hospital Day 2. Medications: Propofol at 10.8 ml/h, vasopressin, norepinephrine, octreotide, and pantoprazole. (ASPEN, 2025) Inputs & Outputs Fluid intake and output on Day 1: INTAKE: 3750 ml Oral:- OUTPUT: 1660 ml Urine: 440 ml Nasogastric (NG): 1220 ml (brown) Drains: - Ostomy: - Stool: On meds: Y or N Blood glucose: None available In goal range: Not applicable Receives insulin: No Abdomen: Distended with absent bowel sounds
Biochemical Data Abdomen: Distended with absent bowel sounds Laboratory test results: Sodium Potassium Chloride Carbon dioxide Glucose Blood urea nitrogen (BUN) Serum creatinine (SCr) Triglycerides (TGs) lonized calcium Phosphorus Magnesium Bilirubin (Bili) Aspartate aminotransferase (AST) Alanine aminotransferase (ALT) Alkaline phosphatase (ALP) Arterial blood gases (ABGS) pH 132 mEq/L 5 mEq/L 97 mEq/L 27 mEq/L 148 mg/dl 56 mg/dl 1.74 mg/dl 1.03 mg/dl 3 mg/dl 1.9 mg/dl 4.8 mg/dl 7260 U/L 193 U/L 7.36 98 mm Hg - Partial pressure of oxygen (pO2) Partial pressure of carbon dioxide (CO2) Bicarbonate Albumin 35 mm Hg 22 mEq/L 1.5 g/dl Note: Your pharmacy compounds with a 15% amino acid solution that intrinsically provides 0.85 mEq of acetate per gram of protein. 36-y-o woman acute variceal bleed status/ She has been intubated for airway protection and is on mechanical ventilation. She is showing signs of acute kidney injury. Pertinent past medical history: Alcohol abuse, hepatic steatosis, esophageal varices, portal hypertension, and gastrointestinal (GI) bleed. Nutrition problem: History of poor oral intake prior to admission and a current history of alcohol intake of approximately 1L (ASPEN, 2025) Doctor orders & cont medical chart Reason for consult: Initiate PN for intestinal obstruction per physician's referral (Hospital Day 2) Nutrition problem: History of poor oral intake prior to admission and a current history of alcohol intake of approximately 1 L/d Weight history: Unable to obtain Current weight: 77.2 kg (170 lb) Height: 165 cm (65 in) Weight assessment: Admission weight of 69 kg (152 lb) Physical examination: Bilateral 2+ pitting edema of ankles; generalized edema of both hands (ASPEN, 2025) Open navigator ▲ 23 tv tps://app.nearpod.com/presentation?pin=A9BQC zoom O Open navigator ▲ tv zoom Nutrition Goals Nutrition goals: 1650 kcal/d (Penn State equation); 90 g of protein (1.3 g/kg/d based on admission weight); 1380 ml/d (20 ml/kg/d) Diet: Nothing by mouth per physician Intravenous (IV) access: Triple-lumen central venous catheter (CVC), right internal jugular vein IV fluids: No current maintenance IV fluid; 0.9 normal saline (NS) infusing at 100 ml/h until 0800 hours on Hospital Day 2. Medications: Propofol at 10.8 ml/h, vasopressin, norepinephrine, octreotide, and pantoprazole. (ASPEN, 2025) Inputs & Outputs Fluid intake and output on Day 1: INTAKE: 3750 ml Oral:- OUTPUT: 1660 ml Urine: 440 ml Nasogastric (NG): 1220 ml (brown) Drains: - Ostomy: - Stool: On meds: Y or N Blood glucose: None available In goal range: Not applicable Receives insulin: No Abdomen: Distended with absent bowel sounds
Basic Clinical Lab Competencies for Respiratory Care: An Integrated Approach
5th Edition
ISBN:9781285244662
Author:White
Publisher:White
Chapter22: Chest Tubes
Section: Chapter Questions
Problem 2SEPT
Related questions
Question
1. Write goal PN macronutrients using a 2-in-1 formulation.
2. What consideration for amino acid concentration needs to be assessed?
3. Would you start this patient on goal dextrose for Day 1?
4. Would you add ILE on Day 1? Why or why not? If so, what amount?
5. Assess and determine electrolyte additives. Assess calcium–phosphate compatibility.
6. What other additives would you include in the Day 1 PN?
Transcribed Image Text:Biochemical Data
Abdomen: Distended with absent bowel sounds
Laboratory test results:
Sodium
Potassium
Chloride
Carbon dioxide
Glucose
Blood urea nitrogen (BUN)
Serum creatinine (SCr)
Triglycerides (TGs)
lonized calcium
Phosphorus
Magnesium
Bilirubin (Bili)
Aspartate aminotransferase (AST)
Alanine aminotransferase (ALT)
Alkaline phosphatase (ALP)
Arterial blood gases (ABGS)
pH
132 mEq/L
5 mEq/L
97 mEq/L
27 mEq/L
148 mg/dl
56 mg/dl
1.74 mg/dl
1.03 mg/dl
3 mg/dl
1.9 mg/dl
4.8 mg/dl
7260 U/L
193 U/L
7.36
98 mm Hg
-
Partial pressure of oxygen (pO2)
Partial pressure of carbon dioxide (CO2)
Bicarbonate
Albumin
35 mm Hg
22 mEq/L
1.5 g/dl
Note: Your pharmacy compounds with a 15% amino acid solution that intrinsically provides 0.85 mEq of
acetate per gram of protein.
Transcribed Image Text:36-y-o woman acute
variceal bleed status/
She has been intubated for airway protection and is on
mechanical ventilation.
She is showing signs of acute kidney injury.
Pertinent past medical history: Alcohol abuse, hepatic
steatosis, esophageal varices, portal hypertension, and
gastrointestinal (GI) bleed.
Nutrition problem: History of poor oral intake prior to
admission and a current history of alcohol intake of
approximately 1L (ASPEN, 2025)
Doctor orders & cont
medical chart
Reason for consult: Initiate PN for intestinal obstruction per
physician's referral (Hospital Day 2)
Nutrition problem: History of poor oral intake prior to admission
and a current history of alcohol intake of approximately 1 L/d
Weight history: Unable to obtain
Current weight: 77.2 kg (170 lb)
Height: 165 cm (65 in)
Weight assessment: Admission weight of 69 kg (152 lb)
Physical examination: Bilateral 2+ pitting edema of ankles;
generalized edema of both hands (ASPEN, 2025)
Open navigator ▲
23
tv
tps://app.nearpod.com/presentation?pin=A9BQC
zoom
O
Open navigator ▲
tv
zoom
Nutrition Goals
Nutrition goals: 1650 kcal/d (Penn State equation); 90 g of
protein (1.3 g/kg/d based on admission weight); 1380 ml/d (20
ml/kg/d)
Diet: Nothing by mouth per physician
Intravenous (IV) access: Triple-lumen central venous catheter
(CVC), right internal jugular vein
IV fluids: No current maintenance IV fluid; 0.9 normal saline
(NS) infusing at 100 ml/h until 0800 hours on Hospital Day 2.
Medications: Propofol at 10.8 ml/h, vasopressin,
norepinephrine, octreotide, and pantoprazole. (ASPEN, 2025)
Inputs & Outputs
Fluid intake and output on Day 1:
INTAKE: 3750 ml
Oral:-
OUTPUT: 1660 ml
Urine: 440 ml
Nasogastric (NG): 1220 ml (brown)
Drains: -
Ostomy: -
Stool: On meds: Y or N
Blood glucose: None available
In goal range: Not applicable
Receives insulin: No
Abdomen: Distended with absent bowel sounds
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