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Case Report NutritionalManagement of total gastrectomystatus post HCL ingestion as asuicide attemptJennifer Risler.
ARAMARK HealthcareDietetic InternAlbany Medical CenterMarch 11th 201311 23 2020 Risler Clincal Case Report 1.
Objectives Review Disease State Evidence Based Guidelines forgastrectomy Present Case Study.
Nutrition Care Process11 23 2020 Risler Clincal Case Report 2 Disease State Mental IllnessDepression and Psychosis Depression .
Medical Illness that causesfeelings of sadness and loss of Chronic Illness that requires long term treatment Risk Factors.
Symptoms11 23 2020 Risler Clincal Case Report 3 Disease State Mental IllnessDepression and Psychosis Psychosis .
Subtype of major depression may be outof touch with reality Causes hallucinations Audio hearing voices Delusions altered thought patterns.
Visual visible people Symptoms11 23 2020 Risler Clincal Case Report 4 Disease State Mental Illness Usuallyin a hospital setting.
Medications Antidepressants Selective Serotonin Reuptake Inhibitors SSRIs Serotonin and norepinephrine Reuptake Inhibitors SNRIs Norepinephrine and dopamine reuptake inhibitors NDRIs .
Antipsychotics target the neurotransmitters that allowcommunication between nerve cells in the brain thatregulate the ability to perceive information around us Risperidone Olanzapine Therapy.
Nerve Stimulation Uses electrical impulses to alter brain activity11 23 2020 Risler Clincal Case Report 5 The affects of nutrition on MentalHealth Illness.
Mental health illnesses can alter nutrition status Diet can affect depression and changes in mood Studies have showed that daily consumption orsupplementation of essential nutrients are effective inreducing the symptoms of depression.
Vitamins Minerals Omega 3 Fatty Acids Amino Acid supplements can reduce symptoms byconverting into neurotransmitters which can ease theseverity of depression Include phenylalanine and tyrosine which cause arousal.
Fatty Acids their structure may decrease thedevelopment of depression DHA helps with appropriate brain growth and development leading to prolonged and decreased symptoms Carbohydrates Fruits Vegetable... help alleviate.
Low Glycemic Index Foods provide a long lastingeffect on brain chemistry and mood11 23 2020 Risler Clincal Case Report 6 Each year over 30 000 people diefrom suicide.
94 suicides a day 11th leading cause of death 83 of suicide attempts involve11 23 2020 Risler Clincal Case Report 7 Evidenced Based Guidelines.
Gastrectomy removal of the Stomach s main functions secretes hormones to aid in Study was performed including90 participants who all.
underwent a total gastrectomy11 23 2020 Risler Clincal Case Report 8 Evidenced Based Guidelines Participants 90 mixed gender.
Total gastrectomy Median Weight 158 pounds Wide range of Body Mass Index BMI Post Operative Nutrition 58 received IV fluids only.
42 received TPN11 23 2020 Risler Clincal Case Report 9 Evidenced Based Guidelines Results indicated that being on TPNvs IV fluids did not have a significant.
effect on recovery of the prevalenceof post operative complications It took an average of 9 days totransfer into enteral feeds tostimulate the GI tract and promote.
it s function These patients ended up being on POfeeds after recovery11 23 2020 Risler Clincal Case Report 10 Case Presentation.
48 year old female with underlyingconditions of depression and psychosis Previously hospitalized Acute Kidney Injury Adequate appetite PTA and following a.
regular diet No weight loss prior to admission Suicide attempt by ingesting HCL Underwent multiple procedures andoperations to determine severity of the.
11 23 2020 Risler Clincal Case Report 11 Procedures Esophagogastroscopy Gastrectomy Splenectomy .
Duodenal Resection Partial Omentectomy Debridement of fat necrosis Abdominal Washout ABThera wound vacuum .
Esophagectomy Jejunostomy Tube Placement11 23 2020 Risler Clincal Case Report 12 Nutrition Care Process The nutrition care process is used to.
provide nutrition interventions andassess patients needs Includes 4 steps Assessment Client history food and nutritionhistory anthropometric data biochemical data.
and nutrient needs Diagnosis Problem signs symptoms and Interventions diet changes nutrition support Monitoring and Evaluation tolerance and11 23 2020 Risler Clincal Case Report 13.
Assessment Client History 48 year old female Following regular diet No food allergies11 23 2020 Risler Clincal Case Report 14.
Assessment AnthropometricMeasurements InitialNutrition Assessment Height 69 inches Weight 103 kilograms 226 6 .
BMI 33 class 1 obesity11 23 2020 Risler Clincal Case Report 15 Assessment AnthropometricMeasurements Follow Up Assessment March 5th 2013 .
Height 69 inches Weight 93 kg 205 BMI 30 Obese Follow Up Assessment March 12th Height 69 inches.
Weight 83 kg 183 BMI 27 Overweight11 23 2020 Risler Clincal Case Report 16 Fun Facts Stomach weighs about 2 3.
Spleen weighs 5 3 ounces lessthan 1 pound11 23 2020 Risler Clincal Case Report 17 Assessment Biochemical Data Serum lab values that can be.
affected by kidney failure Sodium potassium BUN creatinine and phosphorus Goal WNL11 23 2020 Risler Clincal Case Report 18.
Assessment Biochemical DataDate Sodium Potassiu Chloride Urea Phosphorus Pre 135 m 99 109 Nitrogen 2 4 4 7 albumin145 3 4 4 8 7 22 mg dL 18 45 mg 1 29 144 128 37 .
1 30 148 3 9 128 41 3 7 1 31 144 3 8 120 43 5 9 2 1 142 3 8 117 50 5 8 2 4 4 52 2 140 4 0 109 28 3 8 2 7 7 82 6 144 3 5 109 54 3 9 .
2 11 150 4 2 118 109 3 0 2 13 141 3 9 110 99 3 7 2 22 150 4 1 124 52 2 6 3 1 141 3 8 113 42 2 4 3 7 116 20 2 0 .
3 11 140 4 1 98 18 2 3 15 011 23 2020 Risler Clincal Case Report 19 Assessment Nutrient Needs Nutrient needs were based onpatients current state.
Nutrient needs were calculatedfor patients acute kidney injury protein and based on if anytreatment was initiated Nutrient needs were adjusted.
many times throughouthospitalization11 23 2020 Risler Clincal Case Report 20 Assessment Nutrient NeedsUpon Initial Nutrition Assessment 2 1 13.
Admit Ideal Energy Protein FluidWeight Weight103 kg 66 kg 145 25 kcal kg 1 g kg IBW 227 Energy 25 kcal x 66 kg IBW approximately 1 650 calories.
Protein 1 0 grams x 66 kg approximately 66 gramsUpon Follow Up Assessment 2 4 13Admit Current Energy Protein FluidWeight Weight103 kg 115 4 kg 18 kcal kg 1 5 1 7 22 mL kg.
227 253 current g kg IBWEnergy 18 kcal x 115 4 weightkg approximately 2 000 caloriesProtein 1 5 g x 66 kg approximately 100 grams protein1 7 g x 66 kg approximately 110 grams protein.
Fluid 22 mL x 66 kg approximately 1 500 milliliters 1 511 23 2020 Risler Clincal Case Report 21 Assessment Nutrition Needs Continued Upon Fifth Follow Up AssessmentEnergy Protein Fluid.
103 kg 93 kg 205 20 kcal kg 1 5 2 0 g kg 30 mL kg IBW 227 current IBWEnergy 20 kcal x 93 kg approximately 1 800 caloriesProtein 1 5 g x 66 kg approximately 100 grams2 0 g x 66 kg approximately 130 grams.
Fluid 30 mL x 66 kg approximately 2 000 milliliters 2 liters Upon Sixth Follow Up AssessmentAdmit 3 12 13 Current Energy Protein FluidWeight Weight.
103 kg 83 7 kg 20 25 1 5 2 0 g kg 30 mL kg 227 183 kcal kg IBW IBWEnergy 20 kcal x 84 kg approximately 1 700 calories25 kcal x 84 kg approximately 2 100 caloriesProtein and Fluid stayed the same as above assessment.
11 23 2020 Risler Clincal Case Report 22 Assessment Nutrition StatusClassification The patients nutrition status isclassified on a points system.
Normal Moderate Severe These classifications represent a timeframe for follow up.
The categories Nutrition Hx FeedingModality Unintentional Wt loss Weightstatus Serum Albumin Prealbumin and Condition11 23 2020 Risler Clincal Case Report 23.
Assessment Nutrition Classification The patient scored Severe forfirst few nutrition assessments Severe 12 points Points 14.
4 points NPO TPN 2 BMI 30 4 Serum Albumin 2 4 4 Multiple Trauma The patient scored moderate for.
following nutrition assessments11 23 2020 Risler Clincal Case Report 24 Diagnosis Upon Initial Assessment Problem Related To As.
Problem Altered GI Related to Necrotic As evidenced totalFunction NC stomach and by gastrectomy 1 4 damage to partialmultiple GI duodenectomy organs esophagectomy.
and splenectomyProblem Related To AsProblem Altered Related to Acute kidney As evidenced BUN 49 high Crnutrition injury by 6 high related lab Phosphorus 5 5.
values NC high plan to2 2 start CRRT andHD secondary toHD catheter11 23 2020 Risler Clincal Case Report 25.
Diagnosis Upon Follow Up AssessmentRelated To AsProblem Inadequate Related to Current TF As evidenced by 10 kg 22 enteral regimen weight loss.
nutrition since lastinfusion NI nutrition2 3 assessment 3 5 13 perweights in.
current TFyields 82 calorie needs 84 proteinneeds and RN.
decrease TFpatients c o ofdiscomfort11 23 2020 Risler Clincal Case Report 26 Interventions.
1 Parenteral Nutrition IV Fluids TPN recommendations were providedfor this patient if she was not startingCRRT or HD TPN recommendationswere provided based on her initial.
nutrition assessment calculated needs GOAL TPN 150 grams dextrose 65 gramsprotein 25 grams lipids and replenishingelectrolyte PRN TOTAL TPN yields 1 530 calories and 65.
grams of protein 11 23 2020 Risler Clincal Case Report 27 Interventions 2 Parenteral Nutrition IV Fluids Goal TPN for CRRT 300 gramsdextrose 135 grams protein 25 grams.
lipid with replenishing electrolytes as TPN Yield 1 816 calories and 135 grams Goal TPN for HD 300 grams dextrose 100 grams protein 25 grams of lipidand replenishing electrolytes as.
needed 11 23 2020 Risler Clincal Case Report 28 Interventions 3 Enteral Nutrition ND 2 1 Upon starting tube feeds oncemedically feasible recommend.
peptamen bariatric 10 mL hr Increase 10 mL every 6 hours to goal65 mL hr When approximately 75 ofTF is tolerated 40 50 mL D C TPN Until TPN D C change TPN to 325.
grams dextrose 90 grams protein and20 grams lipid11 23 2020 Risler Clincal Case Report 29 Interventions 4 Enteral Nutrition ND 2 1 .
Once patient becomes more medicallystable recommend changing TF to a moreappropriate formula Recommend Repleteat 65 mL hr x 24 hours TF will yield 1 560 mL vol 1 560 calories 97.
grams protein Continue 350 mL water bolus every 4 hours Add 1 packet of Juven BID to provide additional120 calories and 30 grams protein TF and Juven Yields 1 680 calories and 127.
grams of protein 20 kcal kg and 1 5 g kg protein 11 23 2020 Risler Clincal Case Report 30 Interventions 5 Enteral Nutrition ND 2 1 Once patient can tolerate new tube.
feed recommend nocturnal tubefeeding of Replete 130 mL hr x 12hours 1800 0600 Add 1 packet Juven BID TF Yields 1 560 mL vol 1 560 calories and.
97 grams of protein TF and Juven Yields 1 680 calories and 127grams protein 20 kcal kg and 1 5 g kg11 23 2020 Risler Clincal Case Report 31 Interventions .
6 Enteral Nutrition ND 2 1 Recommend change tube feed to a moreconcentrated formula of Isosource 1 5 at 100mL hr x 12 hours secondary to patientcomplaints of abdominal pain and discomfort .
Add 135 mL water bolus every three hours tomaintain hydration Continue with 1packet Juven BID Patient lost 10 kg since previous assessment thisformula will provide additional calories and protein.
TF provides 1 200 mL vol 1 800 calories and 82grams of protein11 23 2020 Risler Clincal Case Report 32 PO Intake Clear Liquid Diet for comfort.
Spit Fistula Patient received a spit fistula on herneck to collect her saliva and anyliquids she does consume for comfortand flavor .
11 23 2020 Risler Clincal Case Report 33Disease State: Mental IllnessDepression and Psychosis. Depression: Medical Illness that causes feelings of sadness and loss of interest . Chronic Illness that requires long-term t

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