What would you recommend now and why

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Reference no: EM133635995

Case: Today is hospital day #4 and the nurse notes fluid oozing from a site on the patient's lower left side of the abdomen where an area of cellulitis had been observed the day before. The patient is taken back to the OR to examine the area, remove abdominal packs, wash out the area, and replace the wound vac. Subsequently, the patient is diagnosed with a high output fistula in the lower jejunum. A metabolic cart study completed after surgery today reflects a resting energy expenditure rate of 3650 calories/d.

Vitals: I/Os: 4100/3850+ Temp: 101.5 Blood Pressure: 122/68 MAP: 62

Finger sticks: 195 (4 u) 185 (4 u) 190 (4 u) 185 (4 u)

Meds: morphine, propofol @ 28 mL/hr, antibiotics

Labs:

Sodium: 139 (135-145) Potassium: 4.0 (3.5-5.5) Chloride: 108 (99-112) Bicarb: 26 (22-29) Glucose: 164 (65-99) BUN: 20 (8-24) Creatinine: 1.1 (0.6-1.1) GFR: > 90 (>60)

CRP: 245 (<1.0) Albumin: 1.4 (3.5-5.5) Phosphorus: 2.2 (2.3-4.7)

Magnesium: 1.9 (1.8-3) Triglycerides: 265 (40-160)

WBC: 15.2 (4-11) Hemoglobin: 13.9 (11-15.8)

Question: What would you recommend now and why? Complete the appropriate nutrition support order form if necessary - complete if you are recommending changes. Discuss your plan for reassessment

Reference no: EM133635995

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