Nutrition Support of the Critically Ill Trauma Patient Lab Assignment Pt is a 25-year-old man admitted to the ER seconda
Posted: Wed Apr 20, 2022 8:49 am
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. How do a trauma patient’s energy and protein needs change
over time? Would a single measure of energy expenditure via
indirect calorimetry be beneficial in determining the adequacy of
the patient’s nutrition support regimen?
2. The patient was receiving continuous jejunal tube feedings at
a rate of 50 mL/h and a gastric residual volume was 100 mL/h. Is
this an indication of intolerance to enteral nutrition?
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. How do a trauma patient’s energy and protein needs change
over time? Would a single measure of energy expenditure via
indirect calorimetry be beneficial in determining the adequacy of
the patient’s nutrition support regimen?
2. The patient was receiving continuous jejunal tube feedings at
a rate of 50 mL/h and a gastric residual volume was 100 mL/h. Is
this an indication of intolerance to enteral nutrition?