21. A hospitalized 37yo female with a history of diabetes has recently undergone
ID: 122979 • Letter: 2
Question
21. A hospitalized 37yo female with a history of diabetes has recently undergone esophageal surgery to remove a suspected cancerous tumor. She will be unable to take in sufficient nutrition orally. Herheight is 4'11", and her weight is 110#. Her physician does not want her to lose weight. (1) Indicate which type of feeding tube would be most appropriate for her. (2) Using this information and our class tubefeeding formulary, you will need to calculate her caloric, protein, and water needs. Isob caletes SDs prokm 1S0on (3) Recommend an appropriate tubefeeding including water flushes (based on a continuous rate) ucerhn 1. 22. Before you could get your recommendations written (for the patient above) an expeditious new doctor wrote an order for Jevity 1.2 at 40cc/hr x 24 hrs per day with 180cc water QJD.s a (1) You need to calculate what this order provides (cals, protein, water). (2) Then indicate the percentage (%) of the doctor's order compared to her calculated needs for total cals, protein, and water [Ex: the doctor's order provides only 50% of her caloric needs, 35% of protein needs, and 120% of water needs). 23. After a week of tubefeeding for the patient above, a biopsy report indicated that the tumor was cancerous, and it metastisized to her stomach, liver, and pancreas. The oncologist has determined that aggressive chemotherapy is necessary and that she will likely not be able to tolerate any enteral feedings soon. He wants your recommendation for Central Parenteral Nutrition (CPN), as he plans to put in a PICC line. Your hospital uses a mixture of 5% protein, 25% dextrose (referred to as CPN 5/29, and 250cc bottles of 20% lipids. (1) You need to calulate the amount of CPN 5/25 she needs, and the continuous rate of infusion. (2) Then indicate how many of the bottles of lipid she will need each day.Explanation / Answer
(22) Jevity (1.2 ) @ 40 cc/hr
It start at 20 mL/hr, titrate by 10-20 mL/hr every 4.5 hours to goal
180 cc free water flushes every 4 hours (62.5 mL/hr)
Macronutrients required calculated as follows:
Feed calories 2016.2 kcal (25 kcal/kg)
Total protein 93 gm (1.2 gm/kg)
Total carbs 285.1 gm
Total fat 66.2 gm
Fluid:
Feed water 1356 mL
Water flushes 1504 mL (250 mL Q4hr)
Total fluids 2853 mL (36 mL/kg)
Daily needs 2800 mL (35 mL/kg/day)
Anthropometrics as comparing to doctor’s orders:
Ideal BW 66 kg
Actual BW 80.6 kg (21% above IBW)
Nutritional BW 80 kg
BMI 27.62 kg/m2
BMI Classification1 – Overweight
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