36 year old male, diagnosed with Cohn's Disease 3 years ago. He is being admitted to the hospital with acute exacerbation of this disease. He reports increasingly severe abdominal pains and cramping. He has been experiencing multiple episodes of diarrhea daily for several weeks, and is currently running a low grade fever of 100 degrees. His home medication regimen included a multivitamin with minerals, and corticosteroids. He will be started on Humira while in hospital. To allow bowel rest a PICC line will be placed and TPN started. Ht 5'9", Wt 140#, his wt six months ago was 168#. The nutrition support team has been consulted.
1. What do you find in his history and physical that is consistent with his diagnosis of Chron's? Explain.
2. He has been treated previously with corticosteroids. His physician is planning to start Humira during this admission. Explain the mechanism for each of these medications in the treatment of Crohn's.
3. The patient is currently on a multivitamin and mineral supplement. Explain why he may be at risk for vitamin and mineral deficiencies.
4. Evaluate the patient's % UBW and BMI.
5. Calculate his energy and protein requirements.
6. Complete a PES statement for this nutrition problem: Unplanned, significant weight loss related to...
7. The members of the nutrition support team note his serum phosphorus and serum magnesium are at the low end of the normal range. Why might that be of concern?
Case Questions (Part 2):
1. The patient underwent resection of 200 cm of jejunum and proximal ileum. The ileocecal valve was preserved. He did not have an ileostomy, and his entire colon remains intact. How long is the small intestine, and how significant is this resection?
2. What nutrients are normally digested and absorbed in the portion of the small intestine that has been resected?
3. He has been placed on parenteral nutrition support immediately postoperatively, and a nutrition support consult was ordered. Initially, he was prescribed to receive 200 g dextrose/L, 42.5 g amino acids/L, and 1 bottle (250cc) 20% Lipid per day. Lipids are to be run seperately from TPN solution. His TPN was initiated at 50 cc/hr with a goal rate of 85 cc/hr. Do you agree with the team's decision to initiate parenteral nutrition, and at this rate? Will this meet his estimated nutritional needs? Explain. Patient Symptoms of Abdominal Pain Essay Assignment Paper
Calculate: PRO(g); CHO(g); Total kcal from his TPN, and cals from lipids.
1.The patient's symptoms of abdominal pain, cramping, and diarrhea are consistent with the diagnosis of Crohn's disease. Crohn's disease is an inflammatory bowel disease that affects the gastrointestinal tract and can cause these symptoms, as well as weight loss and fever. 2.Corticosteroids are anti-inflammatory medications that can reduce inflammation in the digestive tract and improve symptoms in patients with Crohn's disease. Humira (adalimumab) is a biologic medication that works by targeting a specific protein in the body that is involved in inflammation. By blocking this protein, Humira can help reduce inflammation in the digestive tract and improve symptoms in patients with Crohn's disease. 3.Patients with Crohn's disease are at risk for vitamin and mineral deficiencies because inflammation in the digestive tract can impair nutrient absorption. Additionally, medications used to treat Crohn's disease, such as corticosteroids, can also increase the risk of nutrient deficiencies. The patient's low weight and recent weight loss may also contribute to his risk of nutrient deficiencies. 4.The patient's % UBW (percent usual body weight) can be calculated as (current weight ÷ usual body weight) x 100. Using the patient's current weight of 140 pounds and his previous weight of 168 pounds, his % UBW is 83%. A BMI (body mass index) can be calculated as weight (in kilograms) divided by height (in meters) squared. Using the patient's height of 5'9" (1.75 meters) and weight of 140 pounds (63.5 kg), his BMI is 20.7, which is in the underweight category. 5.The patient's energy and protein requirements can be calculated using his weight and activity level. However, this information is not provided in the scenario, so it cannot be calculated. 6.PES statement: Unplanned, significant weight loss related to Crohn's disease, inflammation, and malabsorption as evidenced by 28-pound weight loss in the past six months, low % UBW, and underweight BMI. serum phosphorus and magnesium levels can be a concern in patients with Crohn's disease because inflammation in the digestive tract can impair nutrient absorption, including these minerals. Additionally, TPN (total parenteral nutrition) can also increase the risk of low phosphorus and magnesium levels if these minerals are not adequately replaced in the TPN solution. Low phosphorus and magnesium levels can lead to a variety of symptoms and complications, including muscle weakness, bone pain, and heart arrhythmias. The nutrition support team may need to adjust the TPN solution to ensure that the patient is receiving adequate amounts of these minerals.
All the explanation is mentioned above in the step.
1.The average length of the small intestine in adults is about 6 meters (20 feet). A resection of 200 cm (2 meters) of the jejunum and proximal ileum represents a significant portion of the small intestine, but the ileocecal valve was preserved, which may help with nutrient absorption. 2.The portion of the small intestine that has been resected is where most of the nutrient absorption takes place, including carbohydrates, proteins, fats, vitamins, and minerals. Specifically, the jejunum is important for the absorption of carbohydrates and amino acids, while the ileum is important for the absorption of bile salts, vitamin B12, and other nutrients. 3.Initiation of parenteral nutrition in patients with Crohn's disease and short bowel syndrome is a common approach to manage malnutrition and support the patient's nutritional status. The decision to initiate parenteral nutrition support in this patient seems reasonable, given his acute exacerbation of Crohn's disease and history of significant bowel resection. The initial TPN prescription appears appropriate and is in line with standard recommendations for initiation of parenteral nutrition. However, the nutrition support team should regularly monitor the patient's clinical and nutritional status and adjust the TPN prescription as necessary to meet his changing needs. To calculate the nutritional content of the TPN solution, we need to know the concentration of amino acids and dextrose in the solution. Assuming a standard concentration of 10% amino acids and 20% dextrose, the TPN prescription would provide: •PRO: 42.5 g/L x 1 L = 42.5 g •CHO: 200 g/L x 1 L = 200 g •Total kcal: (42.5 g PRO x 4 kcal/g) + (200 g CHO x 4 kcal/g) = 940 kcal •
All the explanation is mentioned above in the step.
Calories from lipids: 250 mL x 2 kcal/mL = 500 kcal Therefore, the TPN prescription would provide 42.5 g of protein, 200 g of carbohydrates, and a total of 940 kcal per day, with an additional 500 kcal from the lipid infusion. The total caloric intake from the TPN and lipids combined would be 1440 kcal/day. Whether this will meet the patient's estimated nutritional needs will depend on his individual requirements, which should be regularly assessed and adjusted by the nutrition support team.
This is the full and final answer from best of my knowledge and experience. Patient Symptoms of Abdominal Pain Essay Assignment Paper