Mrs
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Mrs. B is admitted to your acute care facility for treatment of multiple pressure ulcers. She has a stage IV pressure ulcer on her R.heel. a stage II on her L hip and another stage III on her sacrum. The wounds have shown little or no improvement over the last three weeks and the stage II on her L hip developed in the last few days. The area below the R heel wound is cyanotic, and amputation may be required. Her temperature has been consistently running around 100 degrees Fahrenheit. She is on antibiotic treatment for infection in the heel wound.
Mrs. B is a long time resident in a long-term care facility due to a diagnosis of progressive Parkinson's disease. Her weight has dropped by 12 pounds in the past month and by 25 over the past three months. Her appetite is poor. She is a dependent feeder and often will refuse her meals. Mrs. B is unable to walk and can only get into her wheelchair with assistance. The physician has ordered a dietary consult to determine whether a tube feeding is appropriate. A visit to the patient shows an alert, responsive individual. Mrs. B states that "she is eating all she can" and that she is "just not very hungry". She has previously signed medical papers declining any artificial feeding.
The following information is available in the chart:
Admit weight: 98# UBW: 123#
Height: 5'5" (self-reported)
Age: 77
Dx: pressure ulcer stage IV R heel, stage II L hip, stage III sacrum; Parkinson's with mild dementia, anemia, dysphagia, PVD
DO: Regular puree
Labs: Albumin: 2.4 mg/dl
Prealbumin: 6.8 mg/dl
BUN: 32
Creatinine: 0.9
Hemoglobin: 9.2
Hematocrit: 11.0
- Calculate IBW, BMI, %IBW and %UBW.
- Estimate the kcal, protein and fluid needs for this patient. Show your work and provide a rationale for each.
- Define/describe the following terms:
- Dysphagia
- PVD
- Parkinson's Disease
- Identify 2 nutritional problems in order of priority.
- Describe a pureed diet.
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1)
- IBW = 43.25.
- %IBW = 102.7%.
- %UBW = 79.7%.
- BMI = 16.3.
2)
- Total calorie needs = 1116 [BMR * 1.2 (for sedentary life)]
- Protein needs: 35.28 grams
- Fluid intake = 1.7 litres (normal fluid intake)
4)
Dysphagia is the condition in which an individual will develop difficulties in the process of swallowing, and this condition is caused by etiologies that affect the nervous system.
5)
The peripheral vascular disease is caused due to the build-up of plaque, which is termed as atherosclerosis in the blood vessels that are present mostly in the extremities, especially legs as this build-up narrows the blood vessels.
6)
The development of shakes, jerks, stiffness, etc in a person's body due to the etiology of brain disorder is called Parkinson's disease, and this disease is mostly caused by the degeneration of neurons (loss of nerve cells) as an individual age.
7)
The two nutritional problems are:
- Protein deficiency (causes loss of weight)
- Calcium deficiency (important in elderly women)
8)
The pureed diet is a diet where all the food items are provided to an individual in a broken-down form (squashed, squeezed, pressed, etc) for aiding their problems associated with chewing or swallowing.
Step-by-step explanation
1)
IBW for women = 45.5 + (0.91 × [height in centimeters (165 cm here) − 152.4]) = 43.25.
%IBW = (current weight (44.5 kg) divided by ideal weight(43.25)) multiplied by 100 = 102.7%.
%UBW = (current weight (44.5 kg) divided by upper body weight(55.7)) multiplied by 100 = 79.7%.
BMI = weight in kg/ height in square metre = 16.3.
2)
BMR = (10 × weight in kg ( 44.5)) + (6.25 × height in cm(165)) - (5 × age in years (77)) - 161 = 930.25
Protein requirement of women above 70 years of age = 0.36* body weight in pounds(98) = 35.28 grams
