Posted: September 14th, 2022

Mrs. Morris is a 66-year-old woman

Medical Reasoning Case Research: Complete Parenteral Diet Title _____________________________
Chief Grievance CC/Historical past of Current Sickness:
Mrs. Morris is a 66-year-old woman who has been complaining of nausea, vomiting, weak spot, stomach ache and stomach fullness for the previous three days. She has had a fever for the final 24 hours and studies that her mid-abdominal ache is colicky and “crampy”. She states her “Crohn’s” has been appearing up for the previous four weeks with diarrhea, anorexia, excessive fatigue and weight reduction. She is 65 inches tall and weighs 65 kg with a ordinary weight of 75 kg. Mrs. Morris was admitted to the Med/Surg unit with a full small bowel obstruction, a number of adhesions, and exacerbation of Crohn’s illness. She is NPO and an exploratory lap is scheduled with lysis of adhesions and small bowel resection to take away diseased bowel. She is 165 cm tall and weighs 65 kg, although she normally weighs 75 kg. Mrs. Morris was taken to the Med/Surg unit as a result of her small bowel was fully blocked, she had many adhesions, and her Crohn’s illness was getting worse. She is not consuming or ingesting something, and an exploratory lap with lysis of adhesions and small bowel resection to take away diseased bowel is deliberate. Mrs. Morris will likely be NPO postoperatively and it is anticipated that her GI tract is not going to be accessible for at the very least 10-14 days.

Social and Previous Medical Historical past:
Mrs. Morris at present lives alone in a senior dwelling house. Her husband died of pancreatic most cancers 2 months in the past they usually had no youngsters. She has had Crohn’s illness since she was 37 years outdated and was identified with diabetes kind 2, 5 years in the past.

Your Preliminary Nursing Assessment:
GENERAL APPEARANCE: anxious, seems weak and pale
SKIN/INTEG: pores and skin dry, tenting famous, eyes sunken
RESP: breath sounds clear with equal aeration bilaterally, non-labored
CARDIAC: pores and skin pale, heat & dry, S1S2, no edema, pulses 2+ in all extremities
NEURO: alert & oriented x4,
GI/GU: stomach agency and distended. Absent bowel sounds, has not voided but
MISC: complains of crampy, colicky stomach ache in RLQ, eight/10, nausea and vomiting

Preliminary Important Indicators:
T: 100.eight F
P: 110
R: 22
BP: 100/60
O2 sats: 98%

Lab/diagnostic Outcomes:
CBC Present Excessive/Low/WNL?
WBC 15000
HGB 9 g/dL
Primary Metabolic panel Present Excessive/Low/
WNL?
Sodium 146
Potassium three.three
Glucose 165
Albumin 2.9 g/dL
Prealbumin 5 mg
Transferrin 104 mg/dL
BUN 7
Creatinine 1.2

1. What information is RELEVANT and have to be acknowledged by the nurse as clinically vital to the necessity for dietary Help in Mrs. Morris?
RELEVANT information:
CC:

Rationale:

Social & PMH:

Nursing Assessment:

Important Indicators:

Labs:

Doctor Orders for Mrs. Morris:
Start Complete Parenteral Diet (TPN) by peripherally inserted central catheter (PICC).

2. Describe the distinction between Peripheral Parenteral Diet and Complete Parenteral Diet.
Peripheral Diet Peripheral Parenteral Diet Complete Parenteral Diet
% of dextrose allowed
Vascular route required
Benefits

Disadvantages

three. Describe the kinds of parenteral diet options.
2:1 answer three:1 answer

Draw a image of the IV arrange for a 2:1 answer

four. Describe the aim of the parts of Parenteral Diet.
Dextrose
Protein
Lipids
Electrolytes
Nutritional vitamins
Minerals
Drugs that may be added to PN Rationale:

The TPN ordered is a 2:1 TPN answer of Dextrose 20% and Amino Acids 2.75% @100ml/hr., and Lipids or IV Fatty Emulsion (IVFE) 20% to be infused @10ml/hr. (See math calculations at finish of this case examine)

5. Calculate the entire 24 hour caloric content material of the Dextrose, Amino Acids and IVFE (Lipids) for Mrs. Morris.

6. Outline central venous catheter remedy _____________________________________________

7. Is a PICC line a central venous catheter? And if that’s the case, why? _______________________________

eight. Checklist the 5 key parts of the Institute for Healthcare Enchancment (IHI) central line bundle that have to be applied relating to the central venous catheter (CVC).

9. Associated to Mrs. Morris’s TPN and CVC remedy, what nursing precedence (s) will information your plan of care? (these nursing priorities could or might not be written as NANDA diagnostic statements)

10. What interventions will you provoke based mostly on the nursing precedence (s) recognized in # 9?
Nursing Interventions per Nursing Precedence Rationale:

11. What physique techniques will you give attention to based mostly on Mrs. Morris’s TPN remedy and your nursing precedence (s)?

12. Mrs. Morris is in danger for issues as a result of administration of TPN.
a. What are the worst attainable issues to anticipate with TPN administration and CVC administration?
b. What indicators/signs ought to the nurse anticipate to determine the event of this complication? What related nursing motion will should be applied for this complication?
A. Potential Problems (checklist 5) B. Indicators/Signs & related nursing motion to implement

13. What is Mrs. Morris seemingly experiencing or feeling proper now in her scenario?

14. What are you able to do to interact your self with Mrs. Morris’s expertise and present her that she issues to you as a individual?

TPN CALORIC CONTENT MATH CALCULATIONS

A. Elements to memorize
1. The share of substance in answer tells you what number of grams of that substance are current in 100 mL. For instance,

a. 5% Dextrose means there are 5 grams of dextrose in 100 ml. (5g/100mL)

b. four% Amino Acids means there are four grams of amino acids in 100 mls. (4g/100mL)

2. There are:

a. three.four kcal/gram of dextrose

b. four kcal/gram of protein

c. 9 kcal/gram of fats

three. Subsequent, calculate the entire quantity the affected person is receiving in a 24-hour interval. For instance, 10% Dextrose at 100 mL/hr. = 2400 mL in 24 hours. Calculate for every substance within the answer or administration of the TPN.

four. Calculating caloric content material:

a. An individual receiving 1500 ml in a 24-hour interval, of 50% dextrose would obtain what number of energy in a 24-hour interval?

1.) 50 grams dextrose = X grams dextrose

100ml 1500ml

100X = 50 x 1500

X = 75000
100

X = 750 grams of dextrose

2.) three.four kcal = X kcal
1 gram 750 gram

1X = three.four x 750

X = 2550
1

X = 2550 energy from dextrose/24 hours

5. For every substance in TPN, (Dextrose, Amino Acids, IVFE), the above calculations have to be accomplished to calculate the entire caloric consumption for a 24-hour interval.

Order | Check Discount

Tags: Mrs. Morris is a 66-year-old woman