Question 1143

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Question Answered step-by-step Ms. Kay, a 51-year-old woman is admitted to the hospital with a… Ms. Kay, a 51-year-old woman is admitted to the hospital with a history of abdominal pain, significant weight loss and progressive dysphagia. Four months ago, she was diagnosed with gastric carcinoma. She is also known Type 2 Diabetes with blood sugars managed on Metformin. Upon admission, you conduct a physical exam which reveals the following:Weight: 60kgHeight: 170cmBlood pressure: 141/87She also has dry mouth, cracked lips and dry skin. Her hair is thinning in some spots. Ms. Kay reports having lost 10kgs over the last month. She also has lower leg edema present. When asked about her oral intake, she reports that food often gets ‘stuck’ in her throat and she coughs when drinking water. Last night, she only managed a two spoonsful of porridge in the morning, a few pieces of watermelon for lunch and some scrambled egg for dinner. Blood sample:HbA1c 6.9Creatinine 0.3 mg/dLBUN 10.7 mg/dLPotassium 3.5 mml/LPhosphate 2.6 mg/dLSodium 130 mmol/LRBS 85 mg/dLAlbumin 3.5 g/dLCRP 75 mg/LPART 1 – QUESTIONS:Total: 30 marks1. Using what you know of the four steps of Nutrition Assessment, review and comment on the findings of your anthropometric, clinical, biochemical and dietary examination of the patient. Include reference ranges to support all your comments. (28 marks)2. Would you refer this patient to the dietitian? Why/why not? (2 marks) PART 2 – QUESTIONSTotal: 15 marks1) In your opinion, is this patient at risk for refeeding syndrome? Support your answer by explaining your understanding of refeeding syndrome, as well as why you think/do not think she is at risk? (4 marks)2) In view of your answer above, what is your recommendation regarding the start of parenteral nutrition? (2 marks)3) Explain the difference between peripheral parenteral nutrition (PPN) and total parenteral nutrition (TPN)? (8 marks)4) In your opinion, would Ms. Kay be better off with PPN or TPN? Motivate your answer. (1 mark)CASE STUDY – PART 3The surgical team decides to operate on Ms. Kay. They perform a gastrectomy and remove the portion of her stomach which contains the obstruction. Parenteral nutrition is stopped and a nasojejunal (NJ) tube is placed to begin feeding. PART 3 – QUESTIONSTotal:  20 marks1) The dietitian opts for a semi-elemental formula to feed via the NJ. What is a semi-elemental formula and why has she chosen it for this patient? (3 marks)2) In your opinion, should this patient be fed via a bolus method or a continuous method? Motivate your answer by highlighting the differences between both methods. (10 marks)3) Is this patient at risk for aspiration? Why/why not? (2 marks)4) Describe 3 preventative measures to avoid clogging of the tube. (3 marks)5) What are your comments on Ms. Kay’s calorie and protein requirements? (2 marks)?After tolerating the NJ feeds well, the doctor recommends a speech therapist to help with Ms. Kay’s swallowing. After an assessment, the speech therapist suggests Ms. Kay trial puree foods. She manages well on blended porridges, pureed potato and thickened pureed soups. The NJ is removed and she is planned for discharge.PART 4 – QUESTIONSTotal:  15 marks1) Ms. Kay would like some ideas to help manage her poor appetite. Give 5 suggestions she can try at home. (5 marks)2) Ms. Kay is concerned that she is lactose intolerant. She would like some ideas to increase protein and calorie intake without taking in dairy. Give 5 suggestions to help her. (5 marks)3) Ms. Kay has heard about the neutropenic diet and would like some more information on it. Explain your understanding of the neutropenic diet, as well as the foods allowed and not allowed on it. (5 marks) Health Science Science Nursing NUR 102 Share QuestionEmailCopy link Comments (0)

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