Colleen Abbott

Nutrition Assessment: Medical Diagnosis Small Bowel Obstruction (SBO)

Age: 60
Labs:
Gender: Male
3/3
3/5
3/9
3/11
Weight: 77.56 kg
Na
141 136 137 143
Height: 190 cm
K
3.4
3.4
3.9
4.2
BMI: 21 c/w normal
Cl
97
92
100 109
CO2 35
35
27
26
BUN 21
18
16
12
Cr
0.98 0.93 0.80 0.77
PMH: Colon cancer in 2001, chemo for 6
Glu 146 106 106 99
months, depression, arthritis.
Mg2+
2.5
2.1
2.1
Phos
3.6
3.9
3.9
Symptoms: Patient admitted with right hip
replacement. Post-op patient experienced
nausea and vomiting. 3/1: NGT placed for
LIS. 3/3: Small Bowel Series showed
findings of either SBO or severe ileus. 3/4:
Abdominal series flat and upright showed
SBO. NGT with output of 4500 ml. 3/6:
POD #0 s/p exp lap with extensive LOA
with PICC placement to initiate TPN. 3/9:
POD #3 still having abd pain. 3/12: POD
#5, receiving TPN at goal rate. NGT d/cd
on 3/11.

3/13
142
4.0
107
25
12
0.89
80
2.0
4.1

Medications: 3/3: D5W .45% NaCl +KCl

120 ml/hr (490 kcal), D5W .9% NaCl +KCl
125 ml/hr (510 kcal), total (1000 kcal). 3/6:
Ondansetron 4 mg IV Q 8 hours PRN. 3/9:
Protonix. 3/11: Vancomycin. 3/13:
Docusate, NS 40 ml/hr.

Current Diet: 3/3: NPO x2 days

3/5: NPO x4 days,
PPN 3000 ml, 125 ml/hr. (39 ml/kg, 22
kcal/kg, 77% MSJ, 1.1 g/kg protein, 1.4
g/kg lipid)
100 g dextrose/day
85 g protein/day
111 g lipids/day
Diet History: Regular diet
3/7: TPN initiated
3/9: TPN 85 ml/hr. Total Volume: 2040 ml
(26 ml/kg) Total Kcals: 2200 (101% MSJ,
28 kcal/kg)
AA: 100 g, 400 kcals, 666 ml, 1.3
g/kg pro
Dex: 324.5 g, 1100 kcals, 462 ml,
GIR: 2.9
IL: 70 g, 700 kcals, 350 ml, 0.9g/kg
fat
3/11: Clear liquid diet, Ensure clear TID
(600 kcal, 21 g pro), and fruit punch
gelatein TID (270 kcal, 60 g pro)
3/13: GI soft diet
Nutrition Diagnosis utilize PES Statements

1. 3/3 NI-1.2 Inadequate energy intake related to adynamic ileus/ NPO diet order as
evidence by NPO x2 days
2. 3/5: NI-1.2 Inadequate energy intake related to SBO/ NPO diet order as evidence by
NPO x4 days & only meeting partial nutrient needs on PPN.
3. 3/11: NC-1.4 Altered GI function related to SBO s/p exp lap with extensive LOA as
evidence by NPO with need for TPN to meet nutrition needs.
4. 3/13: NI-2.1 Inadequate oral intake related to fair appetite as evidence by po intake 2550% of meals/ supplements.
Nutrition Intervention Nutrition prescription, Interventions with goals
Nutrition Prescription
Intervention with goals
Kcal: 2062 2279 MSJ x1.3
3/3: 1. RC-1.4 Monitor GI function
Pro: 85 101 g (1.1-1.3 g/kg)
Goal: Achieve normal GI function
Fluid: 1940 2328 (25-30 ml/kg)
2. ND-3.2 Monitor electrolytes
Goal: Achieve normal electrolyte balance
3. ND-2.2 If diet not advanced in 3-4 days
start PPN based on goals.
Goal: Patient will receive PO/ nutrition
support within next 3-4 days.
Nutrition Monitoring and Evaluation
Indicator
3/5 1. BD-1.2 Electrolyte profile
2. FH-1.3.2.1 Parenteral nutrition intake
3. FH-1.1.1.1 Total energy intake
4. FH-2.1.4.2 Parental access
5. PD-1.1.5 Digestive system
6. FH-1.2.2.2 Types of food/meals
3/9 1. FH-1.3.2.1 Parenteral nutrition
intake
3/11 1. PD-1.1.5 Digestive system
2. FH-1.2.2.1 Amount of food
3. FH-1.3.2.1 Parenteral nutrition intake

Source
Facility standards
EAL
Online nutrition

Kcal requirements
2062 2279 kcal
(MSJ x1.3)
N/A
2062 2279 kcal

Criteria
3/5 1. Achieve normal electrolyte balance.
2. Tolerate and meet partial nutrient needs
on PPN.
3. Patient will receive po/ nutrition support
within next 3-4 days.
4. If unable to initiate diet in 5-7 days
recommend placing PICC line and
changing to TPN.
5. Achieve normal GI function.
6. When medically feasible start clear
liquids and advance to GI soft.
3/9 1. Meet nutritional needs on TPN.
3/11 1. Patient will tolerate diet
advancement.
2. Eat >50% of meals/ supplements.
3. Once patient is consuming >60% of
solid meals, half rate TPN starting at 7 pm,
let the bag run out then discontinue.
Protein requirements
85 101 g (1.1-1.3
g/kg)
N/A
Based on individual

Fluid requirements
1940 2328 ml (2530 ml/kg)
N/A
2328 ml (30 ml/kg)

care manual

(MSJ x1.3)

nutrition assessment

References:
1. Academy of Nutrition and Dietetics. International Dietetics and Nutrition Terminology
(IDNT) Reference Manual. Chicago, IL: American Dietetic Association; 2013.
2. Evidence Analysis Library. Academy of Nutrition and Dietetics Web site.
www.adaevidencelibrary.com. Accessed March 16, 2015.
3. Academy of Nutrition and Dietetics. Nutrition Care
Manual. http://www.nutritioncaremanual.org. Accessed March 16, 2015.
https://www.nutritioncaremanual.org/topic.cfm?
ncm_category_id=11&lv1=255519&lv2=255701&ncm_toc_id=255701&ncm_he
ading=&
https://www.nutritioncaremanual.org/topic.cfm?
ncm_category_id=1&ncm_toc_id=19309&ncm_heading=Nutrition
%20Care&ncm_content_id=82328#CalculationsforNutritionAssessment
https://www.nutritioncaremanual.org/topic.cfm?
ncm_category_id=11&lv1=255287&lv2=255304&ncm_toc_id=255307&ncm_he
ading=&
4. Small Bowel Series http://www.danburyhospital.org/~/media/Files/Patient
%20Education/patiented-english/pdf_Diagnostic/smallbowel.ashx