Case Report: Nutritional Management of Acute Respiratory Distress Syndrome
Objective: The purpose of the clinical case report was to provide the intern with the opportunity to apply the nutrition care process to a complex critical care patient that requires enteral or parenteral nutrition support.
Competencies Met:
CRD 1.3) Intern provided the justification behind the interventions or care provided to patient using appropriate evidence or data
CRD 3.1a) Intern is able to assess the nutritional status of individuals within a hospital setting utilizing standardized nutrition language
CRD 3.1b) Nutrition problem diagnoses and associated PES statement(s) created
CRD 3.1c) intern is able to plan and implement nutrition intervention(s) to include prioritizing the nutrition diagnosis, formulating a nutrition prescription, establishing goals, and selecting and managing the interventions(s)
CRD 3.1d) Monitoring and evaluation goals and tools used to determine the impact of interventions on the nutrition diagnosis are clearly identified
Abstract: Intensive care units (ICU) are one of the most complex areas to work in the health care field. Patients in the ICU are often times complex with new issues that develop as their length of stay increases. The patient described in this case study is a 49 year old, overweight, woman who initially went to an outside hospital because of “flu like symptoms.” The patient was found to have sepsis secondary to pneumonia, which later developed into acute respiratory distress syndrome (ARDS). The patient was transferred to St. Luke’s to receive advanced critical care treatment. Upon arrival to the hospital the patient was placed on extracorporeal membrane oxygenation (ECMO), during the patients treatment the patient also required a tracheostomy, cholecystostomy due to cholecystitis, laparotomy (exploratory) for small bowel perforation and necrotic ischemia, as well as parenteral/enteral nutrition therapy. The patient remained in ICU and ventilator dependent even after the case study was complete. The patient also required to assistance of vasopressin and norepinephrine support due to hypotension. Feeding the patient initially was not only complicated due to ventilator support but the patient also required the use of a paralytic “Nimbex.” The patient was started on parenteral nutrition first, which lasted 3 days before the patient could be fed via enteral nutrition. Upon starting enteral nutrition the patient had some toleration issues, experiencing two episodes of emesis upon starting enteral nutrition. The patient’s anthropometrics and nutrition related laboratory values were monitored to ensure adequacy and tolerance.
Competencies Met:
CRD 1.3) Intern provided the justification behind the interventions or care provided to patient using appropriate evidence or data
CRD 3.1a) Intern is able to assess the nutritional status of individuals within a hospital setting utilizing standardized nutrition language
CRD 3.1b) Nutrition problem diagnoses and associated PES statement(s) created
CRD 3.1c) intern is able to plan and implement nutrition intervention(s) to include prioritizing the nutrition diagnosis, formulating a nutrition prescription, establishing goals, and selecting and managing the interventions(s)
CRD 3.1d) Monitoring and evaluation goals and tools used to determine the impact of interventions on the nutrition diagnosis are clearly identified
Abstract: Intensive care units (ICU) are one of the most complex areas to work in the health care field. Patients in the ICU are often times complex with new issues that develop as their length of stay increases. The patient described in this case study is a 49 year old, overweight, woman who initially went to an outside hospital because of “flu like symptoms.” The patient was found to have sepsis secondary to pneumonia, which later developed into acute respiratory distress syndrome (ARDS). The patient was transferred to St. Luke’s to receive advanced critical care treatment. Upon arrival to the hospital the patient was placed on extracorporeal membrane oxygenation (ECMO), during the patients treatment the patient also required a tracheostomy, cholecystostomy due to cholecystitis, laparotomy (exploratory) for small bowel perforation and necrotic ischemia, as well as parenteral/enteral nutrition therapy. The patient remained in ICU and ventilator dependent even after the case study was complete. The patient also required to assistance of vasopressin and norepinephrine support due to hypotension. Feeding the patient initially was not only complicated due to ventilator support but the patient also required the use of a paralytic “Nimbex.” The patient was started on parenteral nutrition first, which lasted 3 days before the patient could be fed via enteral nutrition. Upon starting enteral nutrition the patient had some toleration issues, experiencing two episodes of emesis upon starting enteral nutrition. The patient’s anthropometrics and nutrition related laboratory values were monitored to ensure adequacy and tolerance.