Topic: Nutrition Support John is a 6 feet 1 inches, 58 year old Black male who r
ID: 124760 • Letter: T
Question
Topic: Nutrition SupportJohn 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
1. Is john a good candidate for TPN or enteral feeding? And if so why or why not?
2. List other indications for use of the nutrition support that you selected.
3. What is the difference between PPN and CPN? Explain the conditions under which each is given.
4. What is the difference between a PEG and nasogastric tube. Explain under what conditions would either be considered appropriate to meet nutritional needs.
5. Between enteral nutrition and TPN which is more preferable, and why?
6. Calculate John's IBW, percent IBW, and percent UBW.
7. Calculate John's kcal and protein needs.
8. 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
9. Should john be given TPN would you recommend iron be added? And if so, why or why not?
10. Due to John surgery, which Vitamin would be of concern if added to the TPN solution and why?
11. Calculate a TPN formula for John.
12. 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.
13. How much free water does the formula provide? How much free water would needed additionally
14. 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?
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. 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
1. Is john a good candidate for TPN or enteral feeding? And if so why or why not?
2. List other indications for use of the nutrition support that you selected.
3. What is the difference between PPN and CPN? Explain the conditions under which each is given.
4. What is the difference between a PEG and nasogastric tube. Explain under what conditions would either be considered appropriate to meet nutritional needs.
5. Between enteral nutrition and TPN which is more preferable, and why?
6. Calculate John's IBW, percent IBW, and percent UBW.
7. Calculate John's kcal and protein needs.
8. 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
9. Should john be given TPN would you recommend iron be added? And if so, why or why not?
10. Due to John surgery, which Vitamin would be of concern if added to the TPN solution and why?
11. Calculate a TPN formula for John.
12. 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.
13. How much free water does the formula provide? How much free water would needed additionally
14. 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?
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. 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
1. Is john a good candidate for TPN or enteral feeding? And if so why or why not?
2. List other indications for use of the nutrition support that you selected.
3. What is the difference between PPN and CPN? Explain the conditions under which each is given.
4. What is the difference between a PEG and nasogastric tube. Explain under what conditions would either be considered appropriate to meet nutritional needs.
5. Between enteral nutrition and TPN which is more preferable, and why?
6. Calculate John's IBW, percent IBW, and percent UBW.
7. Calculate John's kcal and protein needs.
8. 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
9. Should john be given TPN would you recommend iron be added? And if so, why or why not?
10. Due to John surgery, which Vitamin would be of concern if added to the TPN solution and why?
11. Calculate a TPN formula for John.
12. 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.
13. How much free water does the formula provide? How much free water would needed additionally
14. 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?
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
Feeding is an important part of nutrition and through which the patient gets all necessary nutrients to the body. And when patients are not able take orally,then the feeding is done through enteral route or as Total parenteral nutrition.
1) In case of Mr.John who has been diagnosed with gastric tumor with metastasis. And if John is fed through enteral feeding he might have problems with digestion and poor absorption because of the presence of gastric tumor. So,he is a good candidate for Total Parenteral Nutrition because that can be planned according to his nutritional needs and his weight and height. And the dosages and formula can be modified as per need of the client.
2) Other indications of TPN
- To prevent malnutrition I patients who are not able to get adequate nutrition through orally or enterally
- It is useful for gastrointestinal disorders like irritable bowel syndrome, chronic diarrhoea, bowel obstruction, severe Crohn's disease where there severe disturbance in digestion and nutritional absorption
- Post major surgeries like Whipple's, colon resection and anastomosis
- Cancer with severe debilitation where TPN plays minimal role in such patients but are helpful minimally.
3) Peripheral Parenteral Nutrition is also a form on of parenteral nutrition, unlike TPN , PPN can be given through smaller peripheral veins and not highly concentrated like TPN because PPn are given as partial nutrition as the patient will be also on other feedings like enteral or oral route.
Examples of PPN:
Conditions where a person's digestive system slows down because of long hospitalisation days.
On the other hand Central Parenteral Nutrition is given through Major veins like jugular,subclavian or femoral veins. These type of Parenteral Nutrition solutions are high in concentrations of nutritive value like Sodium,potassium, amino acids, calcium, lipids.
The difference between these two are the selection of vein sites for administration like peripheral veins and central veins. Depending on the site ,the solution for administration also differs. CPN can be given for longer terms but PPN can be given only for shorter duration along with some other feeding techniques.
4) Percutaneous Endoscopic Gastroscopy is an endoscopy procedure through which a PEG tube is placed in Stomach through abdominal wall to provide nutrition when the patient is unable to consume orally. It is an invasive procedure. This tube can be placed for 3 to 4 months. It is indicated for patients with stroke who has high chances of aspiration, brain trauma, anatomical dysfunction like cleft lip and cleft palate during repair, oral cancer.
Whereas Nasogastric feeding is through a tube which inserted into the stomach through nose for feeding purposes. It can be used for shorter duration. The tube has to be changed within 14 to 21 days and also if there is a blockage. It is indicated for patients post minor surgeries , during some recovery period of illness, to support with extra calories during malnutrition.
5) Enteral feeding is given through gastrointestinal tract, so it helps in natural process of digestion and nutrient absorption . It can be given with ease and requires minimal efforts for maintenance. The feeding will be cheaper and more easy to manage. Patient can have enteral feedings even at home environment.
On the other hand, TPN can be given with the help of experts because to TPN there should be a accessible vein and strict hand hygiene,aseptic techniques should be followed as there are high chances of contamination through contact. It needs observation for inflammation of the site, fluid overload, fluctuations in blood sugars because of higher concentration of carbohydrates in solution. Monitoring lectrolytes is a necessary because of presence of high quantity of macro and micro nutrients. TPN solutions involves cost.
Comparatively, if the patient is an ideal candidate for enteral feeding, then it is best to give enteral feeding than TPN.
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