Pertinent Nutrition Case
The two pertinent nutrition problems that Joe has is to increase his protein needs to aid in the wound healing process and to increase his fluid needs since fluids are lost in burn wounds (Namdar T. et al, 2010). The two main proteins that Joe needs are glutamine and arginine because they are the two main essential amino acids that assist burn victims in recovery (Wolfe R.). Based on those pertinent nutritional problems, Joe has inadequate protein intake (NI-52.1) related to protein losses as evidence by a total protein level of 4.7 and an albumin level of 2.1. Joe also has inadequate fluid intake (NI-3.1) related to fluid losses as evidence by dry mucous membranes in the throat, poor skin turgor, and a weeping skin condition.
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Inadequate fluid intake (NI-3.1) related to fluid losses as evidence by dry mucous membranes in the throat, poor skin turgor, and a weeping skin condition.
Intervention:
1. Patient will being nothing by mouth with enteral nutrition using Impact with Glutamine @ 20 mL/hr. Patient will then be advanced to 20 mL/her. Advance patient from 20 mL/hr every 4 hours to 60 mL/hr as tolerated.
2. Continue administering fluids while monitoring urinary output. Monitor lab values for changes in electrolytes.
Monitoring and Evaluation:
1. Monitor patients energy needs to ensure he is consuming at lease 1930 kcal/day and 94g of protein per day.
2. Total protein levels will increase to a normal range of 6-8 g/dL.
3. Albumin will increase to a normal range of 3.5-5 g/dL.
4. Prealbumin will increase to a normal range of 16-35 mg/dL.
5. AST will decrease to a normal range of 0-35 U/L.
6. C-reactive protein will decrease to a normal level of <1.
7. Creatine serum will decrease to a normal range of 0.6-1.2 mg/dL.
8. Patients potassium levels will decrease to a normal range of 3.5-5.5 mEq/L.
9. Chloride will decrease to a normal range of 95-105 mEq/L.
10. Carbon dioxide will increase to a normal range of 23-30 mEq/L.
11. Magnesium will increase to a normal range of 1.8-3
Inadequate fluid intake (NI-3.1) related to fluid losses as evidence by dry mucous membranes in the throat, poor skin turgor, and a weeping skin condition.
Intervention:
1. Patient will being nothing by mouth with enteral nutrition using Impact with Glutamine @ 20 mL/hr. Patient will then be advanced to 20 mL/her. Advance patient from 20 mL/hr every 4 hours to 60 mL/hr as tolerated.
2. Continue administering fluids while monitoring urinary output. Monitor lab values for changes in electrolytes.
Monitoring and Evaluation:
1. Monitor patients energy needs to ensure he is consuming at lease 1930 kcal/day and 94g of protein per day.
2. Total protein levels will increase to a normal range of 6-8 g/dL.
3. Albumin will increase to a normal range of 3.5-5 g/dL.
4. Prealbumin will increase to a normal range of 16-35 mg/dL.
5. AST will decrease to a normal range of 0-35 U/L.
6. C-reactive protein will decrease to a normal level of <1.
7. Creatine serum will decrease to a normal range of 0.6-1.2 mg/dL.
8. Patients potassium levels will decrease to a normal range of 3.5-5.5 mEq/L.
9. Chloride will decrease to a normal range of 95-105 mEq/L.
10. Carbon dioxide will increase to a normal range of 23-30 mEq/L.
11. Magnesium will increase to a normal range of 1.8-3