Author: Anonymous

Charlie is a 29 year old Asian male who has been receiving a…

Charlie is a 29 year old Asian male who has been receiving aggressive chemotherapy for the past 2 months for a type of leukemia. He has lost 16 lbs. due to persistent nausea and vomiting despite the judicious use of anti-nausea/vomiting medications during this time. Charlie is admitted to the medical floor due to dehydration. His physician has decided to start parenteral nutrition via his implanted catheter in order to get Charlie through his next 2 rounds of chemotherapy because his prognosis for a cure is excellent. A consult for nutrition support has been ordered. MIV @ 120 mL/hr w/20 mEq Kcl. Complete a nutrition assessment.    Ht: 5’11”          Current weight:  159 lbs.              Weight 3 months ago: 175 lbs. Nutrition-focused physical exam: temporal wasting, ribs apparent, prominent bony shoulders, clavicles, and knees. No sign of edema. Current labs: Sodium: 138 (135-145)     Potassium: 4.5 (3.5-5.5)             Chloride: 104 (99-112) Bicarb: 24 (22-29)             Glucose: 96 (65-99)                    BUN: 9 (8-24)                Creatinine: 0.8 (0.6-1.1)   WBC: 5 (4-11)                   Phosphate: 2.6 (2.5-4.5)             Mg: 1.6 (1.5-2.5)           Triglycerides: 195   (

Jess has been on PN for the past 10 days. The following labs…

Jess has been on PN for the past 10 days. The following labs were from a blood draw this morning at 6 am. His PN is running at a goal rate of 85 mL/hour and he has a MIV running at 40 mL/hr. He has also been receiving other fluids from IV antibiotics and he received several fluid boluses yesterday due to a low blood pressure.   Current weight: 95 kg              Weight on admit: 87 kg (25 days ago)         I/Os: 4000/2800 (past 24 hrs) Temperature: 38.7° (101.6° F)    Fingersticks: 220 (6 u), 200 (6 u), 195 (4 u), 200 (6 u) Sodium: 135 (135-145)     Potassium: 5.4 (3.5-5.5)     Chloride: 100 (99-112) Bicarb: 26 (22-29)             Glucose: 240 (65-99)          BUN: 15 (8-24)           Creatinine: 0.9 (0.6-1.1)   WBC: 12.9 (4-11)              Phosphate: 4.5 (2.5-4.5)     Mg: 1.9 (1.5-2.5) Which of the following changes would you recommend regarding his PN?

Charlie is a 29 year old Asian male who has been receiving a…

Charlie is a 29 year old Asian male who has been receiving aggressive chemotherapy for the past 2 months for a type of leukemia. He has lost 16 lbs. due to persistent nausea and vomiting despite the judicious use of anti-nausea/vomiting medications during this time. Charlie is admitted to the medical floor due to dehydration. His physician has decided to start parenteral nutrition via his implanted catheter in order to get Charlie through his next 2 rounds of chemotherapy because his prognosis for a cure is excellent. A consult for nutrition support has been ordered. MIV @ 120 mL/hr w/20 mEq KCl.  Ht: 5’11”          Current weight:  159 lbs.              Weight 3 months ago: 175 lbs. Nutrition-focused physical exam: temporal wasting, ribs apparent, prominent bony shoulders, clavicles, and knees. No sign of edema. Current labs: Sodium: 138 (135-145)     Potassium: 4.5 (3.5-5.5)             Chloride: 104 (99-112) Bicarb: 24 (22-29)             Glucose: 96 (65-99)                    BUN: 9 (8-24)                Creatinine: 0.8 (0.6-1.1)   WBC: 5 (4-11)                   Phosphate: 2.6 (2.5-4.5)             Mg: 1.6 (1.5-2.5)       Triglycerides: 195   (

Charlie is a 29 year old Asian male who has been receiving a…

Charlie is a 29 year old Asian male who has been receiving aggressive chemotherapy for the past 2 months for a type of leukemia. He has lost 16 lbs. due to persistent nausea and vomiting despite the judicious use of anti-nausea/vomiting medications during this time. Charlie is admitted to the medical floor due to dehydration. His physician has decided to start parenteral nutrition via his implanted catheter in order to get Charlie through his next 2 rounds of chemotherapy because his prognosis for a cure is excellent. A consult for nutrition support has been ordered. MIV @ 120 mL/hr w/20 mEq Kcl. Current labs: Sodium: 138 (135-145)     Potassium: 4.5 (3.5-5.5)             Chloride: 104 (99-112) Bicarb: 24 (22-29)             Glucose: 96 (65-99)                    BUN: 9 (8-24)                Creatinine: 0.8 (0.6-1.1)   WBC: 5 (4-11)                   Phosphate: 2.6 (2.5-4.5)             Mg: 1.6 (1.5-2.5)           Triglycerides: 195   (