71 yo male history of: recurrent bowel obstruction, copd, gerd, htn, arthritis, hyperlipidemia. has been experiencing worsening over the last 4 days abdominal pain with distention, malaise, nausea and vomiting, constipation. has had a poor appetite and has only consumed gatorade and juice for last 7 days. Lab values are as follows: sodium-156, potassium-3.4, chloride-114, co2-28, bun-24, creatinine-1.2, glucose-121, albumin-2.7, prealbumin-9, phosphorus-2.4, magnesium-1.7. Dr. prescribed Lasix 40mg PO BID, pantoprazole 40mg PO q24hrs, Simvastatin 20mg PO q24hrs at bedtime, metoprolo 50mg po q24hr, acetaminophen 650mg po q 6hrs. he is on normal saline at 65ml/hr iv. no allergies. NPO. currently weighs 176 lbs but usually weighs 187 lbs. he is 5 foot 10 inches. he has lost 11 lbs in the last 3 weeks 1. What is his NRS 2002 Score? Nutrition assessment showes: mild muscle wasting at temporal area. visible clavicle. skin turgor is poor with marked skin tenting. oral cavity is dry. eyes are sunken. Patient reports he hasn't felt well for about a week. Started having abdominal pain and nausea/vomiting about 6 days ago. Has eaten very little in the last week but has been trying to drink Gatorade or juice. Estimated nutritional needs are: 2,000-2,400 kcal. 96-120g protein. 2,400-2,800ml fluids 2.what are the recomendations for this patient? a. initiate enteral nutrition via NG tube. recommend twocal at 40ml/hr x 22 hrs. b. initiate parenteral nutrition. recommend 800ml d70w, 500ml 10%aa and 250ml 10% lipid. c. you determine patient is at a low nutritional risk and decide to follow up in 3 days. d. rehydrate patient and replete phosphorus, potassium and magnesium. then recheck labs the tpn is started as ordered. on day 2, the patient develops arrhthmias, hypotension, vertigo and shortness of breath. After reviewnig the labs, you determine that: a. the patient needs EN instead. b. the patient is experiencing s/s of refeeding syndrome. you recommend to hold the tpn and replete phosphorus potassium and magnesium. c. the patient's symptoms are unrelated. continue current care 3. after rehydration and repletion of phosphorus, potassium, and magnesium, you are consulted to provide tpn orders. after reviewing the labs, what do you recommend? initiate the following tpn orders for the first 24 hrs: a.800ml d70w, 900ml 12% AA. b. 250l of d70w, 1200ml of 10%aa, 200ml 20% SMOF lipid. c. 400ml d50w, 800ml 10%aa, 1000ml 10% intralipid (soybean oil emulsion) on day 3, the patient undergoes an exploratory lapartomy with extensive small bowel resection. on day 4 he is scheduled to restart tpn. the surgeon would like to allow for gut rest and anastomosis healing for 2-4 days before initiating trophic enteral feedings. you evaluate the patient's lab values: sodium: 148, potassium-3.6, chloride-112, co2-23, bun-22, creatinine-1.1, glucose-325, phosphorus-2.8, magnesium-1.8. 4. after reviewing these labs, how should the tpn be adjusted for day 4? a. 400ml d50w, 800ml 10%aa, 600ml 10% intralipid b. no changes. c. 250ml of d70w, 1200ml of 10% AA, 200ml 20% SMOF lipid
71 yo male
history of: recurrent bowel obstruction, copd, gerd, htn, arthritis, hyperlipidemia.
has been experiencing worsening over the last 4 days abdominal pain with distention, malaise, nausea and vomiting, constipation.
has had a poor appetite and has only consumed gatorade and juice for last 7 days.
Lab values are as follows: sodium-156, potassium-3.4, chloride-114, co2-28, bun-24, creatinine-1.2, glucose-121, albumin-2.7, prealbumin-9, phosphorus-2.4, magnesium-1.7.
Dr. prescribed Lasix 40mg PO BID, pantoprazole 40mg PO q24hrs, Simvastatin 20mg PO q24hrs at bedtime, metoprolo 50mg po q24hr, acetaminophen 650mg po q 6hrs. he is on normal saline at 65ml/hr iv. no allergies. NPO.
currently weighs 176 lbs but usually weighs 187 lbs. he is 5 foot 10 inches. he has lost 11 lbs in the last 3 weeks
1. What is his NRS 2002 Score?
Nutrition assessment showes: mild muscle wasting at temporal area. visible clavicle. skin turgor is poor with marked skin tenting. oral cavity is dry. eyes are sunken.
Patient reports he hasn't felt well for about a week. Started having abdominal pain and nausea/vomiting about 6 days ago. Has eaten very little in the last week but has been trying to drink Gatorade or juice.
Estimated nutritional needs are: 2,000-2,400 kcal. 96-120g protein. 2,400-2,800ml fluids
2.what are the recomendations for this patient?
a. initiate enteral nutrition via NG tube. recommend twocal at 40ml/hr x 22 hrs.
b. initiate parenteral nutrition. recommend 800ml d70w, 500ml 10%aa and 250ml 10% lipid.
c. you determine patient is at a low nutritional risk and decide to follow up in 3 days.
d. rehydrate patient and replete phosphorus, potassium and magnesium. then recheck labs
the tpn is started as ordered. on day 2, the patient develops arrhthmias, hypotension, vertigo and shortness of breath. After reviewnig the labs, you determine that:
a. the patient needs EN instead.
b. the patient is experiencing s/s of refeeding syndrome. you recommend to hold the tpn and replete phosphorus potassium and magnesium.
c. the patient's symptoms are unrelated. continue current care
3. after rehydration and repletion of phosphorus, potassium, and magnesium, you are consulted to provide tpn orders. after reviewing the labs, what do you recommend?
initiate the following tpn orders for the first 24 hrs:
a.800ml d70w, 900ml 12% AA.
b. 250l of d70w, 1200ml of 10%aa, 200ml 20% SMOF lipid.
c. 400ml d50w, 800ml 10%aa, 1000ml 10% intralipid (soybean oil emulsion)
on day 3, the patient undergoes an exploratory lapartomy with extensive small bowel resection. on day 4 he is scheduled to restart tpn. the surgeon would like to allow for gut rest and anastomosis healing for 2-4 days before initiating trophic enteral feedings. you evaluate the patient's lab values:
sodium: 148, potassium-3.6, chloride-112, co2-23, bun-22, creatinine-1.1, glucose-325, phosphorus-2.8, magnesium-1.8.
4. after reviewing these labs, how should the tpn be adjusted for day 4?
a. 400ml d50w, 800ml 10%aa, 600ml 10% intralipid
b. no changes.
c. 250ml of d70w, 1200ml of 10% AA, 200ml 20% SMOF lipid
Step by step
Solved in 2 steps
