Topic: Nutrition Support John is a 6 feet 1 inches, 58 year old Black male who r
ID: 124619 • Letter: T
Question
Topic: Nutrition Support
John is a 6 feet 1 inches, 58 year old Black male who recently retired from bus driving for 40 years. John’s wife reported that John started complaining of chest pain 4 months ago, but recently believes the pain is getting worst. She reported that John’s appetite has been reduced and that he is currently below his normal weight of 180 lbs.
During their visit to the doctor, they discovered that his weight is currently at 160 lbs. Blood work and an Upper GI series test was done. The UGI revealed a tumor in his stomach and he was immediately admitted into the hospital for removal and biopsy of the tumor. It was found to be cancerous and with metastases. John continues to be hospitalized while chemotherapy and radiation therapy begun. His doctor ordered a dietitian consult and asked for john to be fed. John in the meanwhile was given D5NS at 50 cc/hr, until nutritional support administration started.
Objective Data
Gender: Male
Age: 55 y
Height: 6"1"
Weight: 160 lb
UBW: 180 lb
LABS Actual Normal
Hct 30% 33 - 44%
Hgb 11 g/dL 11.5 - 15.5 g/dL
Glucose 91 mg/dL 70 - 110 mg/dL
BUN 11 mg/dL 8 - 18 mg/dL
Alb 2.7 g/dL 4.0 - 6.0 g/dL
Na 130 mEq/L 135 - 145 mEq/L
K 3.6 mEq/ L 3.7 - 5.2 mEq/L
Is john a good candidate for TPN or enteral feeding? And if so why or why not?
List other indications for use of the nutrition support that you selected.
What is the difference between PPN and CPN? Explain the conditions under which each is given.
What is the difference between a PEG and nasogastric tube. Explain under what conditions would either be considered appropriate to meet nutritional needs.
Between enteral nutrition and TPN which is more preferable, and why?
Calculate John’s IBW, percent IBW, and percent UBW.
Calculate John’s kcal and protein needs.
Is there any nutrition concern with John’s lab results? If so what lab results show concern and what does it or they reflect nutritionally
Should john be given TPN would you recommend iron be added? And if so, why or why not?
Due to John surgery, which Vitamin would be of concern if added to the TPN solution and why?
Calculate a TPN formula for John.
Based on a specialized formula of 1.1 kcal/mL/ 72 g PRO per mL and 730 mL free water per mL. Calculate John’s enteral formula at a rate of 65 cc/h to be administered over 24 h.
How much free water does the formula provide? How much free water would needed additionally
Based on your calculated nutrient needs for John, would his needs be met with the nutrition support calculated in question 12? If not what would you recommended?
11. What are some potential complications of TPN?
12. Explain Refeeding Syndrome. How can you prevent this from happening to John?
13. John has recuperated from her surgery and chemotherapy well. After one month on nutritional support, the doctor asked the RD to make a TF recommendation. Describe how you would recommend making the transition from TPN to TF.
Explanation / Answer
Is john a good candidate for TPN or enteral feeding? And if so why or why not?
Total parenteral nutrition (TPN) and enteral nutrition are both valued methods for giving a patient who requirements are particular nutrition sustenance. TPN is a good choice for John as TPN is transported via a dominant vein or peripheral vein. TPN is not used if other subjects take superiority, such as airing, action of infection, etc. Health care professionals use TPN to extend life somewhat than extend demise, and only in fatal cases if other healing events are deliberate. Use of a central vein necessitates operation to place a tube and leaves the body susceptible to contagion. TPN combinations are multifaceted solutions that are adapted based on a patient’s nutritious requirements.
List other indications for use of the nutrition support that you selected.
TPN is suggested for folks without a serviceable gastrointestinal (GI) tract. It is designated in circumstances of sternly undernourished patients who cannot swallow oral feedings, and who are presurgery or postsurgery, or getting radiation or chemotherapy. Patients with illnesses that necessitate relaxing of the bowel or with pediatric GI complaints also may obtain TPN. An operational GI tract contraindicates TPN. Though, TPN is an effective form of treatment when enteral nourishment is not stood or when the gut miscarries.
What is the difference between PPN and CPN? Explain the conditions under which each is given.
PPN includes distillation of nutrients into minor, peripheral veins, typically in the arm. An advanced osmolarity can be allowed with CPN since the superior vena cava has a big width and the blood rapidly thins the TPN solution. Total Parenteral Nutrition is agreed to peoples who are suffering from digestive complaints, or who are having any lengthy consequences of operation or accident. The Peripheral Parenteral Nutrition is only if if a person’s digestive scheme has been congested, or if the patient is not getting sufficient nutrition throughout a lengthy stop in the hospital. However mutually the TPN and the PPN have nearly similar mechanisms, the TPN has a advanced attentiveness of the mechanisms.
What is the difference between a PEG and nasogastric tube. Explain under what conditions would either be considered appropriate to meet nutritional needs.
One mutual kind of nursing tube is a nasogastric (NG) tube, so named since it arrives through the nose (naso-) and its tip finishes up in the abdominal (-gastric). A nasogastric pipe might not be finest for patients who have difficulties swallowing or essential to be fed by pipe for a lengthy age of time due to long-term circumstances. These patients are healthier fed through a gastrostomy tube, a tube that goes into the abdominal straight through the skin. The gastrostomy tube is also recognized as a G-tube. The readings showed a advanced likelihood of management disappointment with a nasal gastric tube. The amount of demises was dissimilar with the two approaches; nor was the complete incidence of opposing proceedings. Members with PEGs may have a healthier superiority of life.
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