1. Mr. McKinley’s admission orders indicate he is being treated for probable sepsis and SIRS. Define these conditions.
2. Describe the metabolic alterations that occur as a result of sepsis and the systemic inflammatory response. Using the medical record information, identify the specific criteria that are consistent with the diagnosis of sepsis.
3. Mr. McKinley had a Roux-en-Y gastric bypass 4 months ago and has lost approximately 100 lbs. Describe this procedure. Identify the most probable nutritional concerns associated with this rapid weight loss/surgical procedure.
4. Using evidence-based guidelines and the research literature, determine whether Mr. McKinley should receive nutrition support. Address the pros/cons of PN versus EN; early enteral feeding; and full versus trophic feeding. Use this discussion to provide rationale for your decisions.
5. How will Mr. McKinley’s bariatric surgery affect your recommendations for nutritional support?
6. Discuss the current literature recommendations for supplementation of omega-3-fatty acids, glutamine, arginine and antioxidants in nutrition support during sepsis.
7. Define refeeding syndrome. How will Mr. McKinley’s recent 100 lb weight loss affect your nutrition support recommendations regarding risk of refeeding syndrome?
8. Assess Mr. McKinley’s height and weight. Calculate BMI and % usual body weight.
9. After reading the physician’s history and physical, identify any signs or symptoms that are most likely a consequence of Mr. McKinley’s admitting critical illness.
10. Identify any abnormal biochemical indices and discuss the probable underlying etiology.
11. Which laboratory measurements are consistent with sepsis and metabolic stress?
12. Assess Mr. McKinley’s current hydration status using the first 24 hours of I/O and the nursing assessment.
13. Determine Mr. McKinley’s energy and protein requirements. Explain the rationale for the method you used to calculate these requirements.
14. Identify the pertinent nutrition problems and the corresponding nutrition diagnoses.
15. Are you able to diagnose Mr. McKinley using the proposed ASPEN/AND criteria for malnutrition? If so, describe the information you used to make this diagnosis.
16. Outline the nutrition support regimen you would recommend for Mr. McKinley. This should include formula choice (and rationale) and rate initiation and advancement.
17. Identify the steps you would take to monitor Mr. McKinley’s nutritional status in the intensive care unit.
18. What factors may affect his tolerance to enteral feeding?
19. Write a note for your initial inpatient nutrition assessment with nutrition support recommendations.