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  • ML/HR - Because of The Abdominal Distension and Excess Residuals

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    Carlyn Lim, an 84-year-old woman with a history of alcoholism and cerebral vascular accident, was admitted with poor oral intake and difficulty swallowing. She is at risk of refeeding syndrome due to her age, chronic malnutrition, and alcoholism. She is also at high risk of aspiration given her age, CVA, nasogastric tube, abdominal distension, and excess residuals. Her current nutrition order of 1 kcal/ml formula at 65 ml/hr meets her protein needs but provides too many calories and insufficient fluids. A better short-term option is to continue the 1 kcal/ml formula at 65 ml/hr to avoid overfeeding and consider advancing the tube into the duod

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    Concept of Nutrition

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    Carlyn Lim, an 84-year-old woman with a history of alcoholism and cerebral vascular accident, was admitted with poor oral intake and difficulty swallowing. She is at risk of refeeding syndrome due to her age, chronic malnutrition, and alcoholism. She is also at high risk of aspiration given her age, CVA, nasogastric tube, abdominal distension, and excess residuals. Her current nutrition order of 1 kcal/ml formula at 65 ml/hr meets her protein needs but provides too many calories and insufficient fluids. A better short-term option is to continue the 1 kcal/ml formula at 65 ml/hr to avoid overfeeding and consider advancing the tube into the duod

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    24 views3 pages

    ML/HR - Because of The Abdominal Distension and Excess Residuals

    Uploaded by

    Franz go
    Carlyn Lim, an 84-year-old woman with a history of alcoholism and cerebral vascular accident, was admitted with poor oral intake and difficulty swallowing. She is at risk of refeeding syndrome due to her age, chronic malnutrition, and alcoholism. She is also at high risk of aspiration given her age, CVA, nasogastric tube, abdominal distension, and excess residuals. Her current nutrition order of 1 kcal/ml formula at 65 ml/hr meets her protein needs but provides too many calories and insufficient fluids. A better short-term option is to continue the 1 kcal/ml formula at 65 ml/hr to avoid overfeeding and consider advancing the tube into the duod

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    of 3

    Concept of Nutrition

    Activity
    1. Re – read the concept of nutrition found in your Fundamentals in Nursing book.
    2. Analyze the case study and do the following:
    a. Answer the given question and provide a rationale
    b. Create Nursing care plan appropriate to the client given
    c. Produce Client health teaching plan.

    Case study

    Carlyn Lim is an 84 year old woman who was admitted with a diagnosis of Cerebro Vascular
    Accident. she is 70 inches tall and weighs 153 lbs with a usual weight of 180 lbs. Her family
    reports that she has a long history of alcoholism. After the first 36 hours of admission, her
    voluntary intake is reported to be very poor. She is unable to communicate with caregivers and
    family and has marked difficulty swallowing. Her latest order is Isocal HCN is ordered at 65
    ml/hr.because of the abdominal distension and excess residuals,

    She has the following lab reports:


    Pertinent admission labs
    Value Normal

    5 to 25
    BUN 42 mg/dl
    mg/dl
    0.5 to 1.5
    Creatinine 1.9 mg/dl
    mg/dl
    135 to 145
    Sodium 151 mEq/dl
    mEq/dl
    3.5 to 5.0
    Potassium 5.1 mEq/dl
    mEq/dl
    3.5 to 5.0
    Albumin 3.1 g/dl
    g/dl

    Questions

    What are her initial estimated calorie, protein, and fluid requirements?

    - 1600 – 2000 kcal/day

    - 90 – 100 g/day protein

    - 1600 – 3000 ml/day

    What metabolic problem is she at risk of developing?

    - refeeding syndrome

    multiple risk factors:


    -elderly

    -chronic malnutrition

    -alcoholism

    What mechanical problem is she at risk of experiencing?

    - aspiration

    multiple risk factors:

    -ederly

    -cva

    -ng tube

    -abdominal distension

    -excess residuals

    Does the latest order meet all of the patient's nutrition needs?

    - protein is okay

    -calories are too much

    - fluid is insufficient

    What is a better option at this point?

    stay with 1 kcal/ml formula

    keep at 65ml/hr to avoid over feeding

    consider advancing tube into duodenum

    What is a long term solution?

    - consider a HN formula to correct chronic protein malnutrition.

    - stay with 1 kcal/ml formula to provide adequate fluid.

    -insert PEG or J tube to decrease aspiration risk.

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