Nutritional status and respiratory function
1. Define the following terms found in the history and physical for Mr. Hayato.
a. Dyspnea:
b. Orthopnea:
c. Pneumothorax:
d. Endotracheal intubation:
e. Cyanosis:
2. What is the relationship between nutritional status and respiratory function? Define respiratory quotient (RQ). What dietary factors affect RQ?
3. What role does nutrition support and nutritional status play in the ability to be weaned?
4. Determine Mr. Hayato’s energy and protein requirements using the Mifflin-St. Jeor equation, the Ireton-Jones equation, and the COPD predictive equations. Compare them. As Mr. Hayato’s clinician, which would you set as your goal for meeting his energy needs? (Show work)
5. Determine Mr. Hayato’s fluid requirements. (Show work)
6. Mr. Hayato was started on Isosource HN @ 25 cc/hr continuously over 24 hours.
a. At this current rate, how many kcalories and grams of protein should he receive per day?
b. Calculate his nutrition prescription utilizing this enteral formula. Include goal rate.
7. What type of formula is Isosource HNx? What is the percentage of kilocalories from carbohydrate, protein, and lipid? Should the patient have been started on a disease-specific formula? Support your responses. What is the rationale for pulmonary formulas?
8. Examine the patient care summary sheet. How much enteral feeding did the patient receive?
9. You read in the physician’s orders that the patient experienced high gastric residuals and the enteral feeding was discontinued. What does this mean, and what is the potential cause of the problem?
10. Dr. McFarland elected to begin peripheral parenteral nutrition using a formula called ProcalAmine. She began the PPN @ 100 cc/hr and discontinued Mr. Hayato’s regular IV of D5 1/2 NS at TKO. What is ProcalAmine, and how much nutrition does this provide?
11. Was this adequate to meet the patient’s nutritional needs? Explain.
12. On day 4, the enteral feeding was restarted at 25 cc/hr and then increased to 50 cc/hr after 12 hours. You document that the ProcalAmine @ 100 cc/hr was also continued. What would have been the total energy intake for Mr. Hayato?
13. Examine the values documented for arterial blood gases (ABGs).
a. On the day Mr. Hayato was intubated, his ABGs were as follows: pH 7.2, PCO2 65, CO2 35, PO2 56, and HCO3- 38. What can you determine from each of these values?
b. On day 3 while Mr. Hayato was on the ventilator, his ABGs were as follows: pH 7.36, PCO2 50, CO2 29, PO2 60, and HCO3- 33. What can you determine from each of these values?
c. On day 5, after restarting enteral feeding and continuing on ProcalAmine, his ABGs were as follows: pH 7.22, PCO2 66, CO2 36, PO2 57, and HCO3- 37. In addition, indirect calorimetry indicated a RQ of 0.95 and measured energy intake to be 1,350 kcal. How does the patient’s measured energy intake compare to your previous calculations? What does the RQ indicate?
14. As Mr. Hayato is prepared for discharge, what nutritional goals might you set with him and his wife to improve his overall nutritional status?
15. Prepare an ADIME note on for day 3/26 his admission day when the nutrition hx was obtained.
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