Author Question: Determine Mr. Walker's energy, protein, and fluid requirements. Provide a rationale for the method ... (Read 34 times)

james · **on:** Aug 21, 2018

Determine Mr. Walker's energy, protein, and fluid requirements. Provide a rationale for the method you have used to estimate his needs.

What will be an ideal response?

Question 2

The MD has decreased the patient's dose of daily aspirin and recommended discontinuing his ibuprofen. Why? How might aspirin and other NSAIDs affect gastroesophageal disease?

What will be an ideal response?

ergserg · **Reply #1 on:** Aug 21, 2018

Answer to Question 1

Energy Requirements:
American Chest Physicians
30-35 kcal/kg of current body weight: 2346-2737 kcal

Protein Requirements:
1.5-2.0 g/kg (per extreme protein wasting/hypermetabolism) x 78.2 kg = 117-156 g/day

Fluid Requirements:
35 mL/kg x 78.2 kg = 2737 mL/day 2700 mL/day
Or
1 mL/kcal x 2747 kcal = 2737 mL/day 2700 mL/day

Fluid needs may need to be altered per I/O records and vital signs (e.g. blood pressure)

Answer to Question 2

Both of these medications can result in gastritis.
Aspirin and NSAIDs cause gastrointestinal disease by 2 independent mechanisms:
topical injury to the mucosa and
systemic depletion of cytoprotective prostaglandins.
Decreasing the aspirin dosage can allow it to provide cardiovascular protection while minimizing its toxic effect on the gastric mucosa