Answer to Question 1
Mr. McKinley is +1430 mL on this day and that is due to the resuscitation of fluid status through the use of normal saline. He is having adequate UOP of 0.9 mL/kg/hr. Although he has edema and obvious fluid overload in the third spaces, he was most likely dehydrated in the intravascular space. Research suggests aggressive fluid management in the acute phase of sepsis, followed by a more conservative approach in the following days.
Answer to Question 2
Nutritional concerns:
- Adequate energy/protein intake
- Preventing micronutrient deficiencies
- Adequate fluid intake/hydration status
- Adherence to a low-residue diet with slow progression towards a normal healthy diet
- Avoidance of foods that may aggravate gas, diarrhea, or bowel obstruction (e.g. high fat foods, carbonated beverages, beans, peas, broccoli, prunes/prune juice, etc.)
Nutritional outcomes:
- Postoperative healing and weight maintenance
- Return to a normal diet (adequate in energy, protein, fiber, and micronutrients)
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