Working With Patient Assignment Help: How to Answer This Question

Students often encounter this when studying fundamental concepts.

What This Question Is About

This question relates to working with patient and requires a structured academic response.

How to Approach This Question

Structure your response with introduction, analysis, and conclusion.

Key Explanation

This topic involves working with patient. A strong answer should include explanation, application, and examples.

Original Question

You are working with an ICU patient, John, who is suffering from a massive cerebral vascular accident and is currently suffering from severe dysphagia. The physician has ordered NG placement and has consulted you, the dietitian, to recommend enteral feeding. You decided to use Jevity 1.2 and recommend the finalized continuous drop feeding that would meet the patient’s needs. Important information in the medical record and in your fellow dietitian’s assessment is below: Biological sex: male Weight: 125lb; Height: 5’3″; Age: 80 years Medical History: atherosclerosis, uncontrolled hypertension Physical activity: low-moderate C4. Ongoing assessment of adequacy of protein provision should be performed. The use of additional modular protein supplements is a common practice, as standard enteral formulations tend to have a high non-protein calorie:nitrogen ratio. In patients with body mass index (BMI) <30, protein requirements should be in the range of 1.2-2.0 g/kg actual body weight per day, and may likely be even higher in burn or multi-trauma patients. (Grade: E) Rationale. In the critical care setting, protein appears to be the most important macronutrient for healing wounds, supporting immune function, and maintaining lean body mass. For most critically ill patients, protein requirements are proportionately higher than energy requirements and therefore are not met by provision of routine enteral formulations. The decision to add protein modules should be based on an ongoing assessment of adequacy of protein provision. Unfortunately in the critical care setting, determination of protein requirements is difficult but may be derived with limitations from nitrogen balance, simplistic equations (1.2-2.0 g/kg/d) or non-protein calorie:nitrogen ratio (70:1-100:1). Serum protein markers (albumin, prealbumin, transferrin, C-reactive protein) are not validated for determining adequacy of protein provision and-should not be used in the critical care setting in this manner. C5. In the critically ill obese patient, permissive underfeeding or hypocaloric feeding with EN is recommended. For all classes of obesity where BMI is >30, the goal of the EN regimen should not exceed 60%-70% of target energy requirements or 11-14 kcal/kg actual body weight per day (or 22-25 kcal/kg ideal body weight per day). Protein should be provided in a range ≥2.0 g/kg ideal body weight per day for Class I and Il patients (BMI 30-40), ≥2.5 g/kg ideal body weight per day for Class III (BMI ≥ 40). Determining energy requirements is discussed in guideline C1. (Grade: D) Rationale. Severe obesity adversely affects patient care in the ICU and increases risk of comorbidities (eg, insulin resistance, sepsis, infections, deep venous thrombosis, organ failure). 142,143 Achieving some degree of weight loss may increase insulin sensitivity, improve nursing care, and reduce risk of comorbidities. Providing 60%-70% of caloric requirements promotes steady weight loss, while infusing protein at a dose of 2.0-2.5 g/kg ideal body weight per day should approximate protein requirements and neutral nitrogen balance, allowing for adequate wound healing. 142 A retrospective study by Choban and Dickerson indicated that provision of protein at a dose of 2.0 g/kg ideal body weight per day is insufficient for achieving neutral nitrogen balance when the BMI is> 40.142 Use of BMI and ideal body weight is recommended over use of adjusted body weight. 0.8 g/kg actual body weight > 2.5 g/kg ideal body weight >2.0 g/kg ideal body weight 1.2-2.0 g/kg actual body weight

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."