Nutrition Support of the Critically Ill Trauma Patient Lab Assignment Pt is a 25-year-old man admitted to the ER seconda

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Nutrition Support of the Critically Ill Trauma Patient
Lab Assignment
Pt is a 25-year-old man admitted to the ER secondary to multiple
gunshot wounds to the left flank, right buttock, and right thigh.
He was taken to the operating room for an exploratory laparotomy,
extensive lysis of adhesions, small bowel resection, repair of the
third portion of the duodenum, and repair of the duodenal wall. Pt
is transferred to ICU. TPN will be initiated rather than enteral
feedings due to the patient’s hemodynamic instability. A
jejunostomy tube is placed. The RD is consulted for an initial
assessment.
The patient was intubated and sedated. Some diet history was
given by his mother. On hospital day 10 his WBC count was elevated
and he presented with a fever. Abdominal distention was noted and
he was taken back to the operating room. He had an abscess in the
right upper quadrant area which was drained. Day 15, enteral
feeding was initiated.
Biochemical Data upon admission (Which are high, low and
normal?)
Na+ 139 mEq/L
K+ 3.9 mEq/L
Chloride 111 mEq/L
CO2 25 mEq/L
BUN 20 mg/dL
Creatinine 0.8 mg/dL
Glucose 115 mg/dL
Hemoglobin 9.5 g/dL
Hematocrit 29%
Phosphorus 4.0 mg/dL
Albumin 2.2 g/dL
Prealbumin 9.8 mg/dL
Alkaline phosphatase 66 U/L
Aspartate aminotransferase 24 U/L
Alanine transaminase 30 U/L
Triglycerides 130 mg/dL
Anthropometrics:
Height 182.9 cm
Weight 96.8 kg
UBW 86 kg
Nutrition-focused physical findings:
No obvious signs of nutrient deficiencies
Social History:
Lives with mother and two younger siblings
Food/Nutrition-Related History:
The patient’s mother reports that her son does not follow any
special diet. NKFA
Questions:
1. Five days following the patient’s return to the operating
room (hospital day #15), it was decided to initiate enteral
nutrition support. Is an immune-modulating enteral formula
indicated at this time? Why or why not? What nutrients in an
immune-modulating enteral formula would benefit this patient and
how would the patient benefit (specifically explain the rationale
and current recs for glutamine, arginine, and omega-3 FA for this
patient population)?
2.
a. When enteral nutrition therapy was
started, the PN was providing 2.0 g/protein/kg/day. Should the
protein provision be increased in the goal enteral nutrition
prescription?
b. How can a
Nitrogen balance test be utilized to determine if protein provision
was sufficient? If he was
receiving a 170g protein, he had a 24-hour UUN result that was 24,
and an abdominal drain output of 1.5 L. How would you adjust
his protein Rx to promote anabolism?