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JT is a 78-year-old female with a history of T2DM, HTN, hyperlipidemia, and Stage 2 sacral pressure ulcer

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JT is a 78-year-old female with a history of T2DM, HTN, hyperlipidemia, and Stage 2 sacral pressure ulcer. She was admitted to the hospital with sudden onset of left-side weakness, and diagnosed with an acute right cerebrovascular accident. The plan after medical treatment and stabilization is for her to be discharged to a facility for acute rehabilitation. After a bedside swallow evaluation was suspicious for dysphagia, a videofluoroscopic swallowing study revealed obvious oropharyngeal aspiration. The patient was made NPO and a PEG tube was placed. A nutrition consult was ordered to recommend enteral tube feeding.

 

Anthropometrics: Height: 5'4", Weight: 130 lbs, UBW reported as 138 lbs. Reports weight loss from UBW to current weight within the last month. IBW: 120 lbs, BMI: 23.1

 

NFPE: mild to moderate fat and muscle wasting. 2.5 cm x 4 cm Stage 2 sacral pressure ulcer Previously consuming regular diet. Wine with dinner. No smoking or tobacco.

 

Medications: Metformin 500 mg BID, hydrochlorothiazide 25 mg daily, Simvastatin 40 mg daily

 

Parameter Value Normal Range (may vary by age, sex, and laboratory)

 

Sodium 142 mEq/L 135-147 mEq/L

Potassium 4.7 mEq/L 3.5-5.5 mEq/L

Chloride 103 mEq/L 98-106 mEq/L

BUN 15 mg/dL 8-23 mg/dL

Cr 0.5 mg/dL 0.7-1.5 mg/dL

Glucose 200 mg/dL 70-110 mg/dL

Hgb 11.2 g/dL 12-16 g/dL (female)

Hct 34.6% 36-47% (female)

Albumin 3.0 g/dL 3.5-5.5 g/dL

 

Questions (B): (please name the reference used):

 

1. Calculate JT's energy, protein and fluids. Justify your recommendations.

 

2. Select a formula. Justify your selection

 

3. Provide an enteral regimen. Include recommendations for administration, initiation, advancement, and goal. Provide recommendations for water flushes, additives, etc. as needed.

 

5. Provide the nutrient provision of your enteral regimen goal. Include total kcal, kcal/kg, protein gm/kg, total water provision in ml, total fiber in gm/day.

 

6. List at least 3 items that should be included in your monitoring?

 

7. Prior to JT's discharge to the rehabilitation facility, what components of the regimen need to be communicated to the long term facility? 

 

Resources & References for Justification:

 

1. Boullata JI, Carrera AL, Harvey L, et al. ASPEN Safe practices for enteral nutrition therapy. J Parenter Enteral Nutr. 2017;41(1):15-103. DOI: 10.1177/0148607116673053

 

 

2. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enteral Nutr. 2016;40(2):159-211.

DOI: 10.1177/0148607115621863

 

 

• 3. White JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Parenter Enteral Nutr. 2012;36(3):275-283. DOI: 10.1177/0148607112440285

 

• 4. Munoz N, Posthauer ME, Cereda E, Schols JM, and Haseler E. The Role of Nutrition for Pressure Injury Prevention and Healing: The 2019 International Clinical Practice Guideline Recommendations. 2020. Adv. Skin Wound Care; 33:123-136. DOI: 10.1097/01.ASW.0000653144.90739.ad