[Solved]: NAME NSC 325 Parenteral Nutrition Case Study 75 points…

NAME NSC 325 Parenteral Nutrition Case Study 75 points Shannon is a 29 year old Caucasian female currently intubated and sedated in the ICU due to domestic abuse. Today is hospital day #3. She had surgery after being admitted from the emergency department to repair her small bowel, colon, liver and spleen due to multiple abdominal stab wounds. Her abdomen is currently firm and distended with negative bowel sounds. She has a nasogastric tube in place which has drained 1800 mL out in the past 24 hours. A triple lumen has been inserted into the superior vena cava. Patient reportedly had been having some health issues prior to admission. She is employed as a lab tech at a local university and told her Mom that she had lost 10 lbs. in the last 2 months due to work-related stress. She was having lots of abdominal cramps and had really lost her appetite. She has two children aged 4 and 6. IV fluids are running at 100 mL/hr with D5W and (1)/(2) normal saline with 20 mEq/d of KCl. I/Os reflect 2 liters of fluid received in surgery. A nutrition support consult has been ordered to start parenteral nutrition. Ht: 5’7” Current Wt: 125 lbs. (~57 kg) Usual Wt: 130 lbs. (2 months ago) Nutrition-focused physical exam: patient appears thin but no overt signs of nutritional deficiencies; abdomen is firm and distended with negative bowel sounds. Current medications: meds for sedation and pain control; antibiotics to decrease infectious complications Labs: Sodium: 135 (135-145) Potassium: 4.0 (3.5-5.5) Chloride: 99 (99-112) Bicarb: 26 (22-29) Glucose: 91 (65-99) BUN: 10 (8-24) Creatinine: 0.8 (0.6-1.1) Albumin: 2.8 (3.5-5.5) Phos: 2.4 (2.5-4.5) Mg: 1.5 (1.5-2.5) WBC: 11 (4-11) Hemoglobin: 12 (11-15.8) Vital Signs: Temp: 100 MAP: 59, 60, 59, 58, 57 I/Os for the past 2 days: hospital day #1: 3240/2500 mL hospital day #2: 2800/2300 mL Complete a nutrition assessment. Address whether parenteral nutrition is indicated or not (5 points): Create 2 PES statements (5 points): P: P: E: E: S: S: Write a nutrition prescription (5 points): Energy: Protein: Fluids: PN goal rate: Calculate how many grams of the following are your goals for PN to meet the above nutrition prescription; show your work (5 points): Grams of Dextrose per day needed: Grams of Protein per day needed: Grams of Fat per day needed: Complete an order form for parenteral nutrition and show your work for how you determined how many milliliters you need from each of the macronutrients. Show how you determined your PN goal rate AND discuss why you chose which “stock” solution you used for determining your PN solution (10 points): Dextrose: Amino Acids: Fat: Fluids: PN Day # _________ Weight used for calculations: ________ kg All additives are based on amount per DAY AMOUNT PER DAY: ☐PN sliding scale insulin – check box to obtain a finger-stick level every 6 hours Dextrose grams Amino acids grams FSBG Regular Insulin subQ Lipids grams Less than 70 mg/dL Call physician Sodium Chloride 100 mEq 140-179 mg/dL 3 units Sodium Acetate 60 mEq 180-199 mg/dL 4 units Sodium Phosphate 0 mEq 200-249 mg/dL 6 units Potassium Chloride 60 mEq 250-299 mg/dL 9 units Potassium Phosphate 20 mEq 300-349 mg/dL 12 units Potassium Acetate 0 mEq 350-399 15 units Magnesium Sulfate 10 mEq More than 400 mg/dL Call physician Calcium Gluconate 10 mEq MVI (Adult) 10 mL Trace Elements 1 mL Regular insulin units Famotidine mg Thiamine mg Folic Acid mg Zinc sulfate mg Vitamin C mg ______Start PN at _____mL per hour for ___ hours and decrease MIV to _____ mL/hr; After 8 hours if FSBG < 200 mg/dL, increase PN to: _____ mL per hour and decrease MIV rate to: _____ mL/hr then after 8 hours if FSBG < 200 mg/dL, increase PN to: ______mL per hour and decrease MIV rate to: _____ ml/hr then after 8 hours if FSBG < 200 mg/dL, increase PN to GOAL RATE of ______mL per hour & decrease MIV rate to: _____ ml/hr TOTAL fluid volume per day is: ________ mL/d (PN rate & MIV rate together) Date for lab draw: ________ ____TPN-A labs (CBC with Diff, CMP, Pre-albumin, Mag, Phos, Calcium, Trig) ____TPN-B labs (BMP, Mag, Phos, Calcium, Albumin) ____Daily weight _____Daily intake and output _____ Other ____________________________