Case Study:Metabolic Stress and Trauma:Open Abdomen. Andrea Rose and Natalie Rohr

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1 Case Study:Metabolic Stress and Trauma:Open Abdomen Andrea Rose and Natalie Rohr

2 Patient Profile Juan Perez 29 yr old, Hispanic male Brought to the ER with a gunshot wound to the abdomen Vomiting blood and complained of severe back and stomach pain 4+ bilateral edema Not allergic to medications/no chronic medical problems Tobacco Use Single - lives with his brother Operations for exploratory laparotomy, gastric repair, control of liver hemorrhage, resection of proximal jejunum

3 Anthropometric Data Day 1: kg (by day 7 in the hospital, he had gained 6.3 pounds) IBW: kg 70 BP: 115/65 Temperature: degrees BMI: 32.1 Obese

4 Energy and Protein Needs Harris Benedict: kcal/day Penn State: kcal/day Protein requirements: 154 g/day NPO, TPN Recommendation to initiate trickle feed of Pivot at 5 ml/hr

5 Date 29-Mar 1-Apr Glucose 164 mg/dl 140 mg/dl BUN 23 mg/dl 25 mg/dl Creatinine serum Total Protein 1.4 mg/dl 1.6 mg/dl 5.2 g/dl 5.1 g/dl Albumin 1.4 g/dl 1.9 g/dl Prealbumin 3.0 mg/dl 5.0 mg/dl TG 274 mg/dl 265 mg/dl ALT 435 U/L n/a AST 190 U/L n/a CPK 182 U/L n/a

6 Medical Treatment - PN Via PN: 2964 kcal, 194 g protein at 3240 ml per day Propofol (medication for sedation) Added 924 kcal Receiving 840 ml a day Total: 3888 kcal per day, 194 g protein

7 Weight Gain Adm Wt: kg / Current Wt: (day 7): 109 kg Reasons for weight gain: Entered hospital with 4+ bilateral edema No stool output Fluid retention based on I/O record Net since admission: ml

8 Diagnosis (PES) Inadequate protein intake (NI-5.6.1) related to metabolic stress and trauma due to a gunshot wound to the abdomen as evidenced by a negative nitrogen balance.

9 Goals for Diagnosis Goal: Provide enough protein in Juan s TPN to ensure that his nitrogen balance is positive in order to heal promptly as well as ingesting enough protein for the body to function properly.

10 Intervention Monitor the amount of protein Juan is receiving to ensure that he is getting adequate amounts in order to help heal his abdominal wound and supply the body.

11 Outcome Continue to monitor his PN support to ensure that he is receiving the correct nutrition to help aid in his wound healing.

12 References C-reactive protein: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved October 26, 2015, from gov/medlineplus/ency/article/ htm DeChicco, R. (n.d.). Contribution of Calories from Propofol to Total Energy Intake. Retrieved October 26, 2015, from org/article/s (95) /abstract Enteral Nutrition and Total Parenteral Nutrition. (n.d.). Retrieved October 26, 2015, from Farrokhi, F., Smiley, D., & Umpierrez, G. (n.d.). Glycemic control in non-diabetic critically ill patients. Retrieved October 26, 2015, from http: // Friese, R. (2012, June 19). Open Abdomen. Retrieved October 26, 2015, from Hayes, G. (n.d.). Nutritional Supplements in Critical Illness. Retrieved October 26, 2015, from Jeejeebhoy, K. (2002, May 14). Short bowel syndrome: A nutritional and medical approach. Retrieved October 26, 2015, from nih.gov/pmc/articles/pmc111082/ Kim, J. (n.d.). Wound Healing. Retrieved October 26, 2015, from edu/gec/user_documents/kimstefankiewiczwoundhealing.pdf Madsen, H. (n.d.). The Hitchhiker's Guide to Parenteral Nutrition Management. Retrieved October 26, 2015, from edu/clinical/departments/medicine/divisions/digestive-health/nutrition-support-team/nutrition-articles/madsenarticle.pdf

13 Metabolism for Energy and the Respiratory Quotient. (n.d.). Retrieved October 26, 2015, from edu/~gross/bioed/webmodules/respiratoryquotient.html Nelms, M., Sucher, K., & Lacey, K. (2016). Disease of the Cardiovascular System. In Nutrition Therapy and Pathophysiology (Third ed). Boston, MA: Cengage Learning. Pataki, L. (n.d.). Nutritional Challenges After Surgery. Retrieved October 26, 2015, from /Pataki_2011_Nutritional_Challenges_After_GIST_Sur.pdf Pivot 1.5 Cal. (n.d.). Retrieved October 26, 2015, from Reference Cards. (n.d.). Retrieved October 26, 2015, from Todd, S. (2006, October 21). Nutrition support in adult trauma patients. Retrieved October 26, 2015, from gov/pubmed/ Trauma, J. (2004, September 1). Nutritional Support: Monitoring (Which Tests and How Often?). Retrieved October 26, 2015, from east.org/education/practice-management-guidelines/nutritional-support--monitoring-(which-tests-and-how-often-) Vacuum-Assisted Closure (VAC) - Wound Care. (2015, June 18). Retrieved October 26, 2015, from Surgery/Wound-Care/Vacuum-Assisted-Closure.htm

Amanda Hernandez FND Parenteral Nutrition Worksheet October 26, 2011

Amanda Hernandez FND Parenteral Nutrition Worksheet October 26, 2011 Amanda Hernandez FND 430-001 Parenteral Nutrition Worksheet October 26, 2011 1. HP needs TPN because he has short bowel syndrome and his GI tract is not functional. His entire jejunum was and proximal