Mrs. B is admitted to your acute care facility for treatment of multiple pressure ulcers
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 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#
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
Albumin: 2.4 mg/dl
Prealbumin: 6.8 mg/dl
BUN: 32
Creatinine: 0.9
Hemoglobin: 9.2
Hematocrit: 11.0
Estimate the kcal, protein and fluid needs for this patient. Show your work and provide a rationale for each.
Identify her nutritional problems in order of priority
What are the considerations regarding initiating a tube feeding? Do you feel that a tube feeding is warranted? Defend your answer.
What are some possible alternatives to the tube feeding?
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