Case Study: Nutrition Support - PDF

## 7.15 NUTRITION SUPPORT **12. Which statement about nutrition support is false?** a) Enteral nutrition is safer than parenteral nutrition. b) Prophylactic insertion of a parenteral nutrition tube in clients with head and neck cancer is standard procedure. c) Enteral nutrition is more cost-effecti...

## 7.15 NUTRITION SUPPORT **12. Which statement about nutrition support is false?** a) Enteral nutrition is safer than parenteral nutrition. b) Prophylactic insertion of a parenteral nutrition tube in clients with head and neck cancer is standard procedure. c) Enteral nutrition is more cost-effective than parenteral nutrition. d) Parenteral nutrition is used when the risk of starvation outweighs the risk associated with the administration of parenteral nutrition in malnourished clients. e) Parenteral nutrition is less physiologic than enteral nutrition. **13. Define the PICC route of PN delivery and explain its three main advantages compared to other PN routes.** 1) 2) 3) **14. Which TPN patients have increased electrolyte requirements?** a) Malnourished patients with refeeding syndrome b) Patients with renal failure c) Patients with liver disease d) Patients with congestive heart failure e) Patients with diabetes mellitus **15. What are criticisms to protocols usually used to initiate enteral nutrition support in ICU clients?** **16. The most common cause of diarrhea in ICU patients is** a) the high strength of the tube feed b) the lack of use of a starter regimen for the tube feed c) the high rate of the tube feed d) the high osmolality of the tube feed e) an altered GI flora due to antibiotic use **17. The following are potential complications of nasoenteric tube feeding except** a) otitis media b) ileal perforation c) myocardial infarction d) empyema e) epistaxis ## CHALLENGE YOUR LEARNING ## CASE STUDY **Objectives** This case will help you assess the nutritional status of a client, outline nutrition care plan goals for her, and plan the detail of her enteral nutrition support regimen. It will also help you realize that nutrition support requires well-developed practice skills and knowledge. **Description** Mrs. M.C. is a 65-year-old Chinese woman who has been residing at the Long Point Long-Term Care facility for the last 5 years. On December 24, she was taken to the emergency room of St. Paul's Hospital in the morning, after regurgitating formula and pulling out her nasogastric tube. During the past 3 years, Mrs. M.C. has been fed exclusively by enteral nutrition because of her severe dysphagia, which resulted from her history of cerebrovascular accidents. She cannot tolerate any oral fluids or food intake. Other consequences of her cerebrovascular accidents, which she had at 60 and 62 years of age, are aphasia, limited understanding of her environment, and very reduced overall mobility. Mrs. M.C. has been gaining weight steadily since her first cerebrovascular accident, from a usual body weight of 155 lb. In addition, Mrs. M.C.'s medical history shows that she has hypercholesterolemia, hypertriglyceridemia, and hypothyroidism. In the past, she used to drink heavily and smoke a pack of cigarettes a week. Mrs. M.C. started to experience fever, agitation, and mild distress in the days before her arrival at St. Paul's Hospital. The physician who examined her observed that she had a congested chest, difficulty breathing, partial airway obstruction with mucopurulent secretions, accumulation of fluids in the sacral area, and naso-labial irritation. Mrs. M.C. received antibiotics, Lasix, and intravenous fluids (D5/0.45 saline with 20 KCl at 125 mL/hr) until a PEG-J tube could be put in place. Unfortunately, because of limited staffing resources and an overload of clients at that time of the year, Mrs. M.C. received intravenous fluids for 15 days until her PEG-J was finally put in place this morning for her tube feed to be started. Mrs. M.C. weighed 185 lb at admission to the hospital, and she presently weighs 180 lb. During this period, her serum transthyretin concentration dropped from 16 to 11 mg/dL (160 to 110 mg/L). 1. What should be done when a client on enteral nutrition support is regurgitating? 2. Give possible reasons why Mrs. M.C. was regurgitating. 3. Why do you think Mrs. M.C. has a fever and congested chest? 4. Why do you think Mrs. M.C. pulled her feeding tube out? 5. Given that Mrs. M.C. is 5'1" tall, what is your interpretation of her usual body weight? 6. What was her weight change in the last 5 years? How can this be explained? 7. What is your interpretation of her body weight at hospital admission? 8. Why was Mrs. M.C. given Lasix? 9. How much energy was Mrs. M.C. receiving through her intravenous fluid infusion? 10. Why did the intravenous solution contain KCl? 11. What is your interpretation of Mrs. M.C.'s current nutritional status? 12. What is Mrs. M.C.'s adjusted body weight? 13. Calculate Mrs. M.C.'s current energy needs (TEE) using the modified Harris-Benedict method. Reminder: BEE for women (kcal/day) = 655 + 9.56 W + 1.85 H – 4.7 A or BEE for women (kJ/day) = 2743 + 40 W + 7.7 H – 19.7 A 14. Determine Mrs. M.C.'s current protein needs. 15. Determine Mrs. M.C.'s current fluid needs. 16. Why do you think a PEG-J was selected as the feeding route for Mrs. M.C. this time? 17. What type of enteral nutrition formula would you give Mrs. M.C.? 18. Select a formula and determine the amount of formula that Mrs. M.C. needs per day to meet her energy and protein needs. 19. What method of administration would you select to tube feed Mrs. M.C. right now? Why?