Professional Documents
Culture Documents
http://www.comfortassisting.com/media/k2/items/dietitianlg.jpg
59 y.o. Male
Introducing SM 55 and 178#
Mother: T2DM
Goal: to achieve a calm, but awake state or light sleep from where the patient can be
easily aroused
Adequate nutrition and hydration are essential for both physical and mental recovery
Electrolyte balance
http://www.corenutrition.org/images/medical_nutrition_therapy_banner.png
Initial Assessment: 7/28
7/28/17
Assessment: Labs:
NPO K 3.0 ()
Nutrition consult re: pt intubated and
Cr 0.5 ()
required EN support via OGT
Propofol @ 14.6 ml/hr Ca 8.3 ()
GI WNL Albumin 2.6 ()
Estimated needs: 1745 kcal (Penn
State equation), 97g PRO, 2436 mL
H2O and daily MVI, thiamine and folic
acid supplements
7/28/17
Diagnosis: Intervention:
1. Unintended wt. loss related to EtOH Promote with Fiber starting @ 35ml/hr
abuse or another unknown etiology as and increase by 15ml/hr Q4H to goal rate
evidenced by wt. loss of 59# (22%) in of 53ml/hr x 24hrs.
~1yr.
-Include 1pk of Prostat (100 kcal and 15g
2. Inadequate oral intake related to
intubation as evidenced by current PRO)
NPO status, OGT in place and request -If not IV fluids, recommend 230mL FWF
for TF recommendations. Q4H
Monitoring/Evaluation: -TF @ goal provides 1757 kcal (with
Tolerance of TF @ goal rate Propofol and Prostat), 95g PRO (with
Changes in Propofol dosage Prostat) and 2,436 mL total H2O
Possible extubation
Follow-Up: 7/31
7/31/17
Assessment: Labs:
Pt was extubated and required EN
support via NGT 7/28/17 7/31/17
Diagnosis: Intervention:
Jevity 1.2 starting @ 35ml/hr and increase
by 15ml/hr Q4H to goal rate of 70ml/hr x
1. Unintended wt. Loss related to EtOH
24hrs.
abuse or another unknown etiology
-If not IV fluids, recommend 180mL FWF
as evidenced by wt. Loss of 59# Q4H
(22%) in ~1yr. -TF @ goal provides 2,016 kcal, 93g PRO
2. Inadequate oral intake related to and 2,436 mL total H2O
pending SLP swallow eval as
evidenced by OGT previously in Monitoring/Evaluation:
place and now NGT in place. Tolerance of TF
SLP eval for ability to advance diet
Ammonia level & mental status
Follow-Up: 8/2
8/2/17
Diagnosis: Intervention:
Continue Jevity 1.2 @ 70ml/hr x 24hrs
1. Unintended wt. Loss related to EtOH with 180 mL FWF Q4H
abuse or another unknown etiology as If pt passes SLP eval, recommend
evidenced by wt. Loss of 59# (22%) in Cardiac diet
~1yr.
Continue thiamine and folic acid
2. Inadequate oral intake related to
pending SLP swallow eval as Weigh pt weekly
evidenced by OGT previously in place Monitoring/Evaluation:
and now NGT in place. Monitor weight changes to adjust TF
or diet to meet needs
Monitor swallowing ability
Fluid status and BNP to adjust FWF
Follow-Up 8/7:
8/7/17
Assessment:
Pt transferred to Telemetry floor
PO intake: 25-75%
Labs WNL
http://1.bp.blogspot.com/-
kl_eI4JgWuc/UWtHW96nanI/AAAAAAAAA4M/CHofeAce4SM/s1
8/7/17
Diagnosis: Intervention:
Continue Cardiac diet with cut-up
1. Unintended wt. Loss related to EtOH solids and soft vegetables
abuse or another unknown etiology
Trial Ensure Enlive BID
as evidenced by wt. Loss of 59#
(22%) in ~1yr. Continue MVI, folic acid, thiamine
2. Inadequate oral intake related to and vit. D
decreased mental/ cognitive
function as evidenced by PO intake Monitoring/Evaluation:
25-75%. PO and supplement intake
No BM x 2 days
Reccd bowel regimen
http://static.abbottnutrition.com/cms-
prod/nourishclinicalstudy.com/img/enlive-3-flavor-
product-photo_tcm1167-49325.png
Evaluation/Reassessment
Summary of Hospital Events 7/28-8/10
1. Alcohol withdrawal: Seroquel and Valium; required one-to-one (8/5) d/t agitation and
change in mental status
2. Delirium tremens
3. PNA: Unasyn
5. Metabolic Encephalopathy
a. Pt remained very confused; given Ativan, Haldol and Seroquel and a psych consult
was ordered
Nutrition Goals
2. No further wt loss
Bayard, M., Mcintyre, J., Hill, K. R., Woodside, J., & Quillen, J. H. (2004).
Alcohol withdrawal syndrome. American Family Physician, 69(6), 1443-1450.
Retrieved from http://www.aafp.org
Burns, M. J., & Lekawa, M. E. (1994). Delirium tremens (M. R. Pinsky, Ed.).
Retrieved August 14, 2017, from Medscape website:
http://emedicine.medscape.com
Heller, J. L., & Zieve, D. (Eds.). (2017, January 1). Delirium tremens.
Retrieved August 14, 2017, from MedlinePlus website:
https://medlineplus.gov/
Kattimani, S., & Bharadwaj, B. (2013). Clinical management of alcohol
withdrawal: A systematic review. Industrial Psychology Journal, 22(2),
100-108. https://doi.org/10.4103/0972-6748.132914
Trevisan, L. A., Boutros, N., Petrakis, I. L., & Krystal, J. H. (1998).
Complications of alcohol withdrawal. Alcohol Health & Research World,
22(1). Retrieved from https://pubs.niaaa.nih.gov