Answer to Question 1
Refeeding syndrome includes the metabolic and clinical changes that can occur when initiating nutrition support of the malnourished patient. When the malnourished patient is fed, hypokalemia, hypomagnesemia, and hypophosphatemia may result due to the rapid introduction of nutriture. Potassium, magnesium, and phosphate tend to experience an intracellular shift to accommodate the starved cells' demands to meet their metabolic needs. Mr. McKinley's rapid weight loss due to bariatric surgery and presentation of electrolyte abnormalities places him at high risk for refeeding syndrome. It would be important to alert the MD of the risk with hypophosphatemia so that electrolytes can be replaced prior to initiation of enteral feeding. Monitoring electrolytes daily with slow advancement of the feeding will assist to prevent the complications of refeeding syndrome.
Answer to Question 2
UBW = 163 lbs / 175 lbs x 100 = 93
BMI = 28.0
Ms. Watson is considered overweight and is probably moderately malnourished due to her loss of 7 of her bodyweight (though, without a time frame in which this weight was lost, one cannot adequately determine if this is considered malnutrition)
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An example of nutrition labeling on a box of cereal.