Answer to Question 1
The RD should monitor the nursing flow sheet for intake/output records. These records will indicate the amount of formula the patient is actually receiving. The intake/output record will indicate gastrointestinal tolerance to the feeding by documentation of urine and/or stool output. Daily weights and fluid balance, which are essential to monitor during nutrition support, will also be documented through this format. Regular monitoring of electrolytes, glucose, BUN, and creatinine within her chemistry laboratory values will indicate systemic tolerance to the enteral feeding.
Answer to Question 2
Her low laboratory values for RBC, Hgb, and Hct all indicate a risk of anemia.
Checking her ferritin and ZPP may allow for diagnosis of a true anemia. Elevated transferrin levels can help indicate iron-deficiency anemia, too.
It is important to note, however, that these values may be affected by her disease state.
Though her RBC is actually decreased, in many patients with COPD, polycythemia is a result of dysregulated feedback abnormalities that result as a response to chronic hypoxia.
Groundhog feeding
Position of patient to assess jugular vein distention
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Hagfish Feeding Apparatus