71 yo male history of: recurrent bowel obstruction, copd, gerd, htn, arthritis, hyperlipidemia. has been experiencing worsening over the last 4 days abdominal pain with distention, malaise, nausea and vomiting, constipation. has had a poor appetite and has only consumed gatorade and juice for last 7 days. Lab values are as follows: sodium-156, potassium-3.4, chloride-114, co2-28, bun-24, creatinine-1.2, glucose-121, albumin-2.7, prealbumin-9, phosphorus-2.4, magnesium-1.7. Dr. prescribed Lasix 40mg PO BID, pantoprazole 40mg PO q24hrs, Simvastatin 20mg PO q24hrs at bedtime, metoprolo 50mg po q24hr, acetaminophen 650mg po q 6hrs. he is on normal saline at 65ml/hr iv. no allergies. NPO. currently weighs 176 lbs but usually weighs 187 lbs. he is 5 foot 10 inches. he has lost 11 lbs in the last 3 weeks 1. What is his NRS 2002 Score? Nutrition assessment showes: mild muscle wasting at temporal area. visible clavicle. skin turgor is poor with marked skin tenting. oral cavity is dry. eyes are sunken. Patient reports he hasn't felt well for about a week. Started having abdominal pain and nausea/vomiting about 6 days ago. Has eaten very little in the last week but has been trying to drink Gatorade or juice. Estimated nutritional needs are: 2,000-2,400 kcal. 96-120g protein. 2,400-2,800ml fluids 2.what are the recomendations for this patient? a. initiate enteral nutrition via NG tube. recommend twocal at 40ml/hr x 22 hrs. c. you determine patient is at a low nutritional risk and decide to follow up in 3 days. d. rehydrate patient and replete phosphorus, potassium and magnesium. then recheck labs 3. After rehydration and repletion of phosphorus, potassium and magnesium, you are consulted to provide TPN orders. After reviewing the labs, what do you recommend next? Initiate the following TPN orders for the first 24 hrs: a. 800ml D70w, 900ml 12% AA b. 250ml of D70W, 12000ml of 10%AA, 200ml 20% SMOF lipid
71 yo male
history of: recurrent bowel obstruction, copd, gerd, htn, arthritis, hyperlipidemia.
has been experiencing worsening over the last 4 days abdominal pain with distention, malaise, nausea and vomiting, constipation.
has had a poor appetite and has only consumed gatorade and juice for last 7 days.
Lab values are as follows: sodium-156, potassium-3.4, chloride-114, co2-28, bun-24, creatinine-1.2, glucose-121, albumin-2.7, prealbumin-9, phosphorus-2.4, magnesium-1.7.
Dr. prescribed Lasix 40mg PO BID, pantoprazole 40mg PO q24hrs, Simvastatin 20mg PO q24hrs at bedtime, metoprolo 50mg po q24hr, acetaminophen 650mg po q 6hrs. he is on normal saline at 65ml/hr iv. no allergies. NPO.
currently weighs 176 lbs but usually weighs 187 lbs. he is 5 foot 10 inches. he has lost 11 lbs in the last 3 weeks
1. What is his NRS 2002 Score?
Nutrition assessment showes: mild muscle wasting at temporal area. visible clavicle. skin turgor is poor with marked skin tenting. oral cavity is dry. eyes are sunken.
Patient reports he hasn't felt well for about a week. Started having abdominal pain and nausea/vomiting about 6 days ago. Has eaten very little in the last week but has been trying to drink Gatorade or juice.
Estimated nutritional needs are: 2,000-2,400 kcal. 96-120g protein. 2,400-2,800ml fluids
2.what are the recomendations for this patient?
a. initiate enteral nutrition via NG tube. recommend twocal at 40ml/hr x 22 hrs.
c. you determine patient is at a low nutritional risk and decide to follow up in 3 days.
d. rehydrate patient and replete phosphorus, potassium and magnesium. then recheck labs
3. After rehydration and repletion of phosphorus, potassium and magnesium, you are consulted to provide TPN orders. After reviewing the labs, what do you recommend next?
Initiate the following TPN orders for the first 24 hrs:
a. 800ml D70w, 900ml 12% AA
b. 250ml of D70W, 12000ml of 10%AA, 200ml 20% SMOF lipid
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