NUTRITION

CARE PROCESS NOTE - NUTRITION FOLLOW UP CLINICAL: 54 yo M with history of ETOH/Hepatitis C, ESLD with transplant 1/2012, readmitted to ICU on 3/4 due to UGI bleed. 14 banded varices on 3/3 done at Peacehealth requiring NPO status for at least 72 hrs or per surgery recs. Potential small bowel ileus per CT scan. SUBJECTIVE: Vet is intubated and unresponsive. NUTRITON-RELATED MEDICATIONS: Ceftriaxone inj,soln ceftriaxone 1 gm Methylprednisolone acetate inj,susp 5mg ivp daily Octreotide inj octreotide acetate 500 mcg Pantoprazole sodium inj,pwdr pantoprazole NUTRITION ASSESSMENT ANTHROPOMETRICS: Weight:146.3 lb [66.5 kg] (03/03/2013 08:00) Ht:66 in [167.6 cm] (01/03/2012 12:51) Wt hx: 3/4 164lbs (s/p 2L fluid resuscitation) 3/3 146lbs 2/27 145lbs 2/26 144.7lbs 2/8 151.6lbs 2/1 150.6lbs 12/6/2012 168lbs BMI: 26.0 IBW = 142 lbs 64.5 kg %IBW = 113.34 DIETARY/ALIMENTATION/ELIMINATION: Current Diet: NPO Appearance: Vet is intubated, jaundiced, ascites and hernia LBM: 3/5 I/O: 741/272 LABS: CHEM 7 PANEL 03/05/2013 07:41 GLUCOSE 195 H UREA NITROGEN 37 H CREATININE 1.3 SODIUM 139 POTASSIUM 4.3 CHLORIDE 111 H CO2 17 L ANION GAP 15 EGFR 58 L SODIUM 139 03/05/2013 07:41 ALBUMIN 2.3 L 03/04/2013 22:19 PREALBUMIN 7.0 L 02/25/2013 15:00 PHOSPHATE 4.2 03/04/2013 22:19 MAGNESIUM 1.8 L 03/05/2013 07:41

 POTASSIUM 4.8 LIVER FUNCTION PANEL 03/04/2013 22:19 PROTEIN,TOTAL 4.6 L ALBUMIN 2.3 L BILIRUBIN, TO 7.8 H ALKALINE PHOS 215 H SGOT (AST) 569 H SGPT (ALT) 251 H CBC 03/05/2013 12:03 WBC 6.3 RBC 2.52 L HGB 7.9 L HCT 23.4 L MCV 92.7 MCH 31.4 MCHC 33.9 RDW 20.0 H PLT 101 L MPV 9.3 HEMOGLOBIN A1C 7.8 H 01/28/2013 08:56 CBGS: 3/5 7am 195 mg/dL 3/4 11pm 135 mg/dL NUTRITION DIAGNOSIS: Suboptimal protein-energy intake r/t recent hematemesis and upper GI bleed on 3/3/2013 as evidenced by NPO diet order for critical illness, 14 banded esphageal varices on 3/3 and potential small bowel ileus. NUTRITION STATUS: severely compromised ESTIMATED NUTRITION NEEDS: Calories = 1686 kcals Protein = 134 g protein Fluid = 2000 mL NUTRITION GOALS: 1. Maintain NPO until further recs per surgery and SLP. NUTRITION RECOMMENDATIONS: 1. Replete Mg (1.7) and Ca+ (ionized 1.07) 2. Start enteral nutrition as soon as possible per surgery recs. 3. If still NPO and unable to initiate enteral nutrition by the end of the week, consider PN. NUTRITION INTERVENTIONS: 1. Diet/Nutrition Delivery -> NPO with no current feeding access NUTRITION MONITORING: RD to follow-up routinely to evaluate nutrition status.