450 ADIME Donald Dominguez

Overview:
Patient is 56 y/o male who was admitted for hyperglycemia after having a blood
sugar greater than 500. Patient had N/V for 5 days and stomach pain for 1 day.
Patient was not able to accurately depict events leading up to hospitalization.

Assessment:
Anthropometrics:
 56 y/o male
 253lb, 250lb on admit (12/13)
 65 inches
 BMI: 42.1 (Obese BMI)
 Weight Hx: Weight loss of 7lb over last couple weeks

Biomedical:
 High glucose (196 mg/dL)
 12/13 High Hemoglobin A1C (11.5)
 12/16 Finger sticks: 189-155
 Ranged 154-264 (12/15)
 Awaiting EGD

Client History:
 MEDICAL HISTORY: non-compliant diabetic (T2DM), HTN, hyperlipidemia,
CAD, osteoarthritis, GERD
 Past surgeries: s/p chole, L-knee arthroscopy
 Family history: significant cardiac disease and T2DM
 Senior accountant who works from home
 Quit smoking 6 years ago
 Divorced with one daughter

Food and Nutrition-Related History

 Current order: tube feeding via NG tube; Jevity 1.2 cal with goal of
96mL/hour, 4 hours on and 4 hours off: This order provides 1382 cal/d and
64g protein/d
 Currently EN on hold for EGD
 24 Hour Recall:
o Breakfast: ½ cup Chorizo, 2 eggs scrambled, 2 flour tortillas, 12 oz.
black coffee
o Lunch: 1 footlong Italian sub (Subway), 1 bag of potato chips, 20 oz.
diet soda
o Dinner: 6 oz. meat (usually pork or beef), 1 cup of rice, 1 cup of pinto
beans, ½ cup vegetable (usually cooked green beans or carrots), 1
flour tortilla
 Allergic to Morphine
  Current Medications: KCl, Protonix Iv, Ondansetron, Dilaudid, Lorazepam,
NaCl, Regular Insulin, Lantus, Furosemide
 Home Medications: ASA, Pepcid, Lisinopril, HCTZ, Metoprolol, Metformin,
Tylenol
 4-5 beers per week at home

Nutrition-Related Physical Findings:

 Pale with dry lips upon admission per H&P
 N/V for 1 week with coffee ground emesis x1 per H&P
 Decreased appetite for a couple of weeks per daughter

Comparative Standards/Calculated Needs:

 2293 kcal/d (Mifflin x 1.2)
 92 g protein/d (DRI)

Diagnoses:
 Inadequate enteral nutrition infusion related to current EN order of Jevity 1.2
at 96mL/hour for 4 hours on and 4 hours off as evidenced by EN providing
1382 cal/d, when needs are 2293 cal/d
 Undesirable food choices related to lack of knowledge or non compliance of
T2DM as evidenced by patient eating over 3000 calories and 269g of
carbohydrate in 24-hour recall

Interventions:
 Prescription: Patient needs 2293 cal/d and 92g protein/d
 Recommend: Modify enteral nutrition to Glucerna 1.0 @ 95mL per hour
 Goals: Meet calorie and protein needs via EN infusion

 Prescription: 45-60g CHO per meal

 Recommend: Nutrition Education with RD, CDE
 Goals: To achieve controlled diabetes condition with improved glucose and
A1C values

Monitoring and Evaluation:

 Indicator: EN rate of Glucerna 1.0 at 95 mL/hour
 Criteria: Will monitor for EN rate of Glucerna 1.0 at 95 mL/hour

 Indicator: 45-60g CHO per meal

 Criteria: Will monitor for 45-60g CHO at meals, will monitor patient’s glucose
and A1C