Mrs. Pember is a 90-year-old nursing home resident who is admitted with a urinary tract infection and fever. She is admitted to the ICU with hemodynamic instability. She is NPO and has received all nutrition and hydration via PEG tube for the last 2 years after developing dysphagia following an acute stroke. Other PMHx: HTN CAD Arthritis Depression GERD H/o aspiration pneumonia Ht: 5 ft 2 in Wt: 104 lb Usual wt per nursing home records: 109 lb last week (Range of 107-109 lb over the last 3 months) Nutrition-Focused Physical Exam Results: Skin turgor: moderate skin tenting, mucous membranes are dry, eyes are sunken Edema: None Muscle mass: Muscles adequately defined Fat mass: Mild fat loss at the triceps and under the eyes Admission Basic Metabolic Panel (BMP) Results: Na 152 K 3.8 Cl 110 CO2 28 BUN 36 Creatinine 2.2 Glucose 156 GFR 55 Enteral feeding plan at the nursing home: She has been stable on Jevity 1.5 @ 45 ml/hr x 22 hours per day with a bolus water flush of 125 ml of free water every 4 hours. She tolerates this plan well. Assess Mrs. Pember’s weight status. Using the GLIM criteria, evaluate Mrs. Pember’s nutritional status. Using the ASPEN/AND malnutrition criteria, evaluate Mrs. Pember’s nutritional status. Evaluate her weight loss over the last week. What has likely caused this? Based on your assessment of her nutritional status and a consideration of her current medical status, when should the PEG feedings be restarted? If Mrs. Pember did not already have a PEG tube and required an NG tube, describe the steps the nurse would take to place the tube. Your facility does not stock Jevity 1.5. Use the nutrition formulary table to select the most appropriate alternate enteral nutrition formula for Mrs. Pember: University of Alabama Medical Center Enteral Nutrition Formulary Jevity 1.0 Glucerna Elecare Nepro TwoCal Impact Peptide 1.5 The attending physician starts Mrs. Pember on antibiotics to treat the urinary tract infection, and IV fluids for hemodynamic instability and dehydration. On Day 2, the physician restarts the PEG feedings and water flushes. On Day 3, Mrs. Pember is experiencing diarrhea. What is likely the cause of the diarrhea? What strategies could you try to address the diarrhea? Evaluate Mrs. Pember’s risk for aspiration. What risk factors does she possess? Describe strategies to reduce Mrs. Pember’s risk of aspiration. A nursing student is in the room to administer medications when you visit Mrs. Pember on Day 4. The nursing student stops the enteral feeding pump, gives a water flush of 30 ml, mixes the medications together and administers them, then flushes the tube again with 30 ml water before restarting the feeding pump. What did the student do wrong? The physician asks you for recommendations on checking gastric residual volumes. What do you recommend? Be specific. As Mrs. Pember is improving, the case manager is preparing for discharge and asks you for advice on whether Mrs. Pember should have EN boluses with cans (using an open system) or continuous feedings (using a closed system). Describe the pros and cons of open vs. closed EN systems. Make a recommendation for Mrs. Pember.

Mrs. Pember is a 90-year-old nursing home resident who is admitted with a urinary tract infection and fever. She is admitted to the ICU with hemodynamic instability. She is NPO and has received all nutrition and hydration via PEG tube for the last 2 years after developing dysphagia following an acute stroke. Other PMHx: HTN CAD Arthritis Depression GERD H/o aspiration pneumonia Ht: 5 ft 2 in Wt: 104 lb Usual wt per nursing home records: 109 lb last week (Range of 107-109 lb over the last 3 months) Nutrition-Focused Physical Exam Results: Skin turgor: moderate skin tenting, mucous membranes are dry, eyes are sunken Edema: None Muscle mass: Muscles adequately defined Fat mass: Mild fat loss at the triceps and under the eyes Admission Basic Metabolic Panel (BMP) Results: Na 152 K 3.8 Cl 110 CO2 28 BUN 36 Creatinine 2.2 Glucose 156 GFR 55 Enteral feeding plan at the nursing home: She has been stable on Jevity 1.5 @ 45 ml/hr x 22 hours per day with a bolus water flush of 125 ml of free water every 4 hours. She tolerates this plan well. Assess Mrs. Pember’s weight status. Using the GLIM criteria, evaluate Mrs. Pember’s nutritional status. Using the ASPEN/AND malnutrition criteria, evaluate Mrs. Pember’s nutritional status. Evaluate her weight loss over the last week. What has likely caused this? Based on your assessment of her nutritional status and a consideration of her current medical status, when should the PEG feedings be restarted? If Mrs. Pember did not already have a PEG tube and required an NG tube, describe the steps the nurse would take to place the tube. Your facility does not stock Jevity 1.5. Use the nutrition formulary table to select the most appropriate alternate enteral nutrition formula for Mrs. Pember: University of Alabama Medical Center Enteral Nutrition Formulary Jevity 1.0 Glucerna Elecare Nepro TwoCal Impact Peptide 1.5 The attending physician starts Mrs. Pember on antibiotics to treat the urinary tract infection, and IV fluids for hemodynamic instability and dehydration. On Day 2, the physician restarts the PEG feedings and water flushes. On Day 3, Mrs. Pember is experiencing diarrhea. What is likely the cause of the diarrhea? What strategies could you try to address the diarrhea? Evaluate Mrs. Pember’s risk for aspiration. What risk factors does she possess? Describe strategies to reduce Mrs. Pember’s risk of aspiration. A nursing student is in the room to administer medications when you visit Mrs. Pember on Day 4. The nursing student stops the enteral feeding pump, gives a water flush of 30 ml, mixes the medications together and administers them, then flushes the tube again with 30 ml water before restarting the feeding pump. What did the student do wrong? The physician asks you for recommendations on checking gastric residual volumes. What do you recommend? Be specific. As Mrs. Pember is improving, the case manager is preparing for discharge and asks you for advice on whether Mrs. Pember should have EN boluses with cans (using an open system) or continuous feedings (using a closed system). Describe the pros and cons of open vs. closed EN systems. Make a recommendation for Mrs. Pember.

Phlebotomy Essentials

6th Edition

ISBN:9781451194524

Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Chapter1: Phlebotomy: Past And Present And The Healthcare Setting

Section: Chapter Questions

Problem 1SRQ

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Related questions

Question

Other PMHx:

HTN

CAD

Arthritis

Depression

GERD

H/o aspiration pneumonia

Ht: 5 ft 2 in Wt: 104 lb

Usual wt per nursing home records: 109 lb last week

(Range of 107-109 lb over the last 3 months)

Nutrition-Focused Physical Exam Results:

Skin turgor: moderate skin tenting, mucous membranes are dry, eyes are sunken

Edema: None

Muscle mass: Muscles adequately defined

Fat mass: Mild fat loss at the triceps and under the eyes

Admission Basic Metabolic Panel (BMP) Results:

Na	152
K	3.8
Cl	110
CO2	28
BUN	36
Creatinine	2.2
Glucose	156
GFR	55

Enteral feeding plan at the nursing home:

She has been stable on Jevity 1.5 @ 45 ml/hr x 22 hours per day with a bolus water flush of 125 ml of free water every 4 hours. She tolerates this plan well.

Assess Mrs. Pember’s weight status.

Using the GLIM criteria, evaluate Mrs. Pember’s nutritional status.

Using the ASPEN/AND malnutrition criteria, evaluate Mrs. Pember’s nutritional status.

Evaluate her weight loss over the last week. What has likely caused this?

Based on your assessment of her nutritional status and a consideration of her current medical status, when should the PEG feedings be restarted?

If Mrs. Pember did not already have a PEG tube and required an NG tube, describe the steps the nurse would take to place the tube.

Your facility does not stock Jevity 1.5. Use the nutrition formulary table to select the most appropriate alternate enteral nutrition formula for Mrs. Pember:

University of Alabama Medical Center

Enteral Nutrition Formulary

Jevity 1.0

Glucerna

Elecare

Nepro

TwoCal

Impact Peptide 1.5

The attending physician starts Mrs. Pember on antibiotics to treat the urinary tract infection, and IV fluids for hemodynamic instability and dehydration. On Day 2, the physician restarts the PEG feedings and water flushes. On Day 3, Mrs. Pember is experiencing diarrhea.

What is likely the cause of the diarrhea?

What strategies could you try to address the diarrhea?

Evaluate Mrs. Pember’s risk for aspiration. What risk factors does she possess?

Describe strategies to reduce Mrs. Pember’s risk of aspiration.

A nursing student is in the room to administer medications when you visit Mrs. Pember on Day 4. The nursing student stops the enteral feeding pump, gives a water flush of 30 ml, mixes the medications together and administers them, then flushes the tube again with 30 ml water before restarting the feeding pump. What did the student do wrong?

The physician asks you for recommendations on checking gastric residual volumes. What do you recommend? Be specific.

As Mrs. Pember is improving, the case manager is preparing for discharge and asks you for advice on whether Mrs. Pember should have EN boluses with cans (using an open system) or continuous feedings (using a closed system). Describe the pros and cons of open vs. closed EN systems. Make a recommendation for Mrs. Pember.

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