Answer to Question 1
The following are possible PES statements. It may be helpful for students to initially write more than two nutrition diagnoses and then prioritize as to the ones that are most likely to have immediate nutrition interventions.
Increased energy expenditure related to hypermetabolism due to traumatic brain injury as evidenced by elevated laboratory values suggestive of acute illness/inflammation and hypermetabolic processes (glucose 125 mg/dL, lactate 2.8 mmol/L, and CRP 155 mg/dL)
Inadequate enteral nutrition infusion related to increased needs d/t TBI as evidenced by only 650 mL of formula provided per I/O chart and estimated receipt of only 43 and 52 of energy and protein needs, respectively.
Answer to Question 2
Mifflin-St. Jeor = 10W + 6.25H 5A + 5
10(97.73) + 6.25(175.26) - 5(48) + 5 = 977.3 + 1095.375 - 240 + 5 = 1837.7 or 1,800 kcal
1837.7 x 1.3 (AF) x 1.1 (SF) = 2628 or 2,600 kcal
EPR = 0.8 x 97.73 = 78-80 g protein.
Gradual weight loss could be addressed in a couple of different ways:
- 500 kcal could be subtracted from 2,600 kcal to promote a 1/wk weight loss (2,100 kcal).
- A 500-kcal deficit could be provided by subtracting 250 kcal from his kcal needs and increasing his activity level by 250 kcal.
- Mr. Gupta's activity level could be increased by 500 kcal/day to provide the 1/wk weight loss, although this is probably unlikely due to possible limitations from past knee surgery.
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