Explain the impact that ventilator support has on a person’s nutritional requirements
Explain the role that dietary intake plays in the management of COPD
Course outcome(s) addressed in this Project:
NS335-2: Explain the use of parenteral and enteral nutrition in special populations.
NS335-3: Create a nutrition care plan for a specific disease state using the nutrition care process.
GEL 1.1: Demonstrate college-level communication through the composition of original materials in Standard American English.
Review the following case study details for a patient with COPD and respiratory failure:
Mr. C is a 72 year old male that was admitted to the hospital 2 days ago complaining of shortness of breath. Mr. C has a complicated medical history that includes: COPD, HTN, depression, obesity, and sleep apnea. Mr. C has smoked since the time he was a teenager. He is a retired auto-mechanic and is married to his wife, Mrs. C. Mr. C is 5’10? and 240 pounds. He has been instructed to follow a heart healthy diet and to lose weight, but his wife reports that he is non-compliant with any dietary therapy. He is currently taking a diuretic, a blood pressure medication, uses an inhaler when SOB, and also takes an anti-depressant. The patient uses a breathing mask at night due to his sleep apnea history. His wife reports that she recently bought him a special multi-vitamin containing omega 3 fatty acids. It is designed to help older men’s hearts and other medical issues.
Upon admission to the hospital, Mr. C’s respiratory status declines, and the ER physician decides to intubate the patient in order to deliver proper oxygenation to the patient. The MD also starts the patient on IV fluids consisting of NS (normal saline) for hydration. While on ventilator support, the patient is sedated and is unable to talk or consume an oral diet. The medical chart notes from the pulmonologist reveal that there are no immediate plans to extubate the patient (wean from the ventilator). Currently, the laboratory lab values of the patient are all within normal limits (WNL). However, upon admission and before vent support was initiated his labs were abnormal. Some affected lab values were: CO2, BUN/Cr, pH, and Na. The patient has had a NPO (nothing by mouth) diet order status for 4 days and has only received IV fluids for intake. The nursing notes reveal that he has normal urine output and bowel sounds are present and normal.
As a nutrition professional working at this hospital, you are to start the nutrition care process on this patient. Your hospital has a protocol to see all patients that have NPO diet orders and/or are on the ventilator for more than 4 days. You have NOT received a doctor’s consult for a tube feeding (enteral) order; however, it is imperative that this patient is assessed and appropriate nutrition recommendations are made.
For this assignment, you will write a descriptive essay concerning COPD. You will explain the disease itself and how you will develop a nutrition care plan for the case study patient. Your descriptive essay should include the following:
Describe COPD, its risk factors, and its common treatments.
Explain Mr. C’s current status. Describe why he was intubated and how vent support can impact a patient. What are the nutrition therapy goals for a patient with COPD receiving vent support?
What are your specific nutrition therapy recommendations for Mr. C while he is on ventilator support? Include estimated calorie and protein requirements and the method(s) for how he should receive these nutrients (enteral, parenteral, or oral diet/supplements). You do not need to include details of specific brands, amounts/serving sizes and/or infusion rates.
If the condition of the patient improves and he is taken off the vent, what are your recommendations for nutrition therapy for Mr. C upon discharge from the hospital? What are some specific diet plans, oral drink supplements or vitamin/herbal therapies that may benefit Mr. C?
Appendix: Write a Nutrition Care Plan/Chart note on this COPD patient addressing the current clinical situation of the patient. Write this note as though you were the nutrition professional caring for this patient in a hospital setting. Please refer to Tables 11-3 and 11-4 in your textbook for information on the ADIME chart note process.
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