ADIME-Donald Dominguez
Assessment:
Overview Information:
Patient is a 56 y/o Hispanic male admitted to the ICU for uncontrolled type II diabetes after being found by his
daughter at home in his bed. The patient was confused and dehydrated and c/o nausea, stomach pain and
hyperglycemia. The patient claims to have not eaten for about a week because of nausea and vomiting. An NG
tube was placed for continued vomiting and patient is receiving Jevity (1.2 Cal).
Client History (CH):
Medical hx:
Type II diabetes (1 year-non compliant)
Hypertension
Hyperglycemia
Hyperlipidemia
Coronary artery disease
Osteoarthritis
GERD
Past Surgeries:
Laparoscopic cholecystectomy-6 years ago
Arthroscopy to left knee- 3 years ago
Allergies:
Morphine
Current Medications/supplements:
Potassium chloride
Protonix (Q12H)
Ondansetron (Q8H)
Dilaudid (PRN Q2H)
Lorazepam (PRN Q4H)
Normal saline (Q8H)
Regular insulin-Humulin (PRN Q4H)
Lantus (Q12H)
Furosemide
Regular insulin- Novolin
Physical Activity:
Sedentary
Anthropometric Measurements (AD):
Ht.: 5’ 5” (165 cm)
Wt.: 253 lb (115 kg)
UBW/weight hx: 250 lb– 7 lb weight loss prior to admission and 6 lb gained since admission
BMI: 42 (obese)
1
Biochemical Data, Medical Test and Procedures (BD):
PaCO2: 42.8 mmHg (high)
HCO3: 29 mEq/L (high)
pH: 7.44 (high)
glucose: 196 mg/dL (high)
BUN: 27 mg/dL (high)
Serum chloride: 98 mEq/L (low)
Serum potassium: 3.6 mEq/L (low)
Serum protein: 7.9 g/dL (high)
ALT: 37 (high)
Magnesium: 1.5 mEq/L (low)
Phosphate: 3.3 mg/dL (low)
Ketones +
A1c: 11.5 (high)
Nutrition-Focused Physical Findings (PD):
Physical appearance:
Skin is dry with no abrasions or wounds (per H & P)
Edema +2 in hands and lower extremities (per progress note)
Decreased bowl sounds in all quadrants
Appetite:
Poor appetite due to painful emesis
Coffee ground emesis
Stomach feels like it is “on fire” (per progress note)
Food/Nutrition Related History (FH):
Food and Nutrient Intake:
Usual intake:
o Morning: chorizo, 2 scrambled egg, 2 flour tortillas, black coffee
o Noon: Italian sub, potato chips, diet soda
o Evening: beef/pork, 1 cup rice, 1 cup pinto beans, ½ cup vegetables, flour tortilla
NPO, ice chips only
Current order:
o Goal: Jevity (1.2 Cal) at 96 mL/hour
o Start at 20 mL/hour, titrate up by 20 mL/hour to goal
o Run Jevity on pump, 4 hours on, 4 hours off
12 hours/day x 96 mL/hour = 1,152 mL/day
1,152 mL/day x 1.2 kcal/mL = 1,382.4 kcal/day
1.152 L/day x 55.5 g pro/L = 63.9 g pro/day
Comparative Standards/Calculated Needs:
Energy needs (Mifflin 1.2):
o ABW = 82.9 kg
o RMR = (10 x 82.9) + (6.25 x 165) – (4.92 x 56) + 5
2
o RMR = (829) + 1,031.25 – 275.52 + 5
o 1,590 x 1.2 = 1,907 kcal/day
Protein needs:
o 1.0 x 83 kg = 83 g pro/day
Nutrition Diagnosis:
P: Inadequate enteral nutrition infusion
E: related to: inappropriate NG tube feeding order of Jevity 1.2 at 96 mL/hour 12 hours/day; 4 hours on, 4
hours off
S: as evidenced by: an order of Jevity 1.2 at 95 mL/hour providing 1,382 cals/day when patient needs are
1,907 kcals/day.
Nutrition Intervention:
Prescription: 1,900 kcals per day and 88 grams protein/day
Recommend: Increase goal rate of EN of Jevity 1.2 to 132 mL/hour which will provide
Goals: achieve goal rate, prevent malnutrition and to meet patient energy and protein needs
Nutrition Monitoring and Evaluation:
Indicator: EN rate
Criteria: Patient’s enteral intake will be monitored for increased in EN rate to 132 mL/hour
