A.

The patient is a 28-year-old female who is 22 weeks and 2 days pregnant with her second child. Her BMI prior to pregnancy was 24.3, which is with normal standards, and her pre-pregnancy weight was 130 lbs. Currently she is 142 lbs, meaning she gained 12 lbs, confirming she is within normal range for a pregnant woman in her second trimester. Due to her socioeconomic status, the patient has not been taking prenatal vitamins and has been eating fast food. This brings concerns that the mother and the baby are not upholding the correct amount of nutrients needed.

B.

Since the patient cannot afford prenatal vitamins, she needs to consume foods that are high in:

Folic acid  (prevent neural tube defects)

• Leafy greens: spinach and kale

• Oranges

• Avocados

  
  

  Iron (prevents anemia and increases blood volume)

• Lean meats

• Spinach

• beans

  
  

  Calcium (helps bone and teeth development)

• Dairy: milk and cheese

  
  

  Omega-3 fatty acids (important for brain development)

• Salmon

• Walnuts

• Chia seeds

  
  

  Vitamin d (for calcium absorption and bone health)

• Milk

• Oranges juice

Besides the foods above, a balanced diet is highly recommended during pregnancy, which includes proteins, carbohydrates, dairy, and fruits and veggies. Some specific nutritious foods are eggs, whole grains, frozen vegetables (which are cheaper), and canned beans.

Some foods that the patient will want to avoid are: 

• Unpasteurized Dairy and Juices (may contain harmful bacteria)

• Raw or Undercooked Eggs, Meat, and Seafood (risk for infection)

• Processed Foods (may contribute to excessive weight gain and gestational diabetes)

Referring the patient to a food bank or discussing cheaper options for prenatal vitamins may be effective as well. 

A.

The woman from the last case study gave birth to her baby at 39 weeks and 2 days. She delivered her child via spontaneous vaginal delivery and weighs 7 lbs and 1 oz, which is well within the normal birth weight range, while not having any urine or fecal output yet. The baby is now the patient and has no medical complications at the moment. The mother is attempting to breastfeed, but the baby is not latching; she is requesting assistance.

B.

The mother is having trouble getting the baby to latch on to her breast as she attempts to breastfeed. 

There are recommendations that could possibly help:

• Postion the baby so that they are close to the breast while holding the breast in a C-hold and guiding the nipple into the baby’s mouth.

• Encourage the baby’s lips and mouth to open wide

• Avoid shallow latching and make sure the baby is latched onto a large portion of the areola

• Comfort during feeding sessions can make the process more relaxing for the mom and baby

Some resources that can be provided to the mom are a recommendation to see a lactation specialist, WIC (free lactation consultations), or a telehealth lactation support (more accessible help).

Part 1: 

Pt is a 33-year-old with PMHx asthma, obesity, and DM who p/w dyspnea and fever. Found to have COVID-19 ARDS. Pt with worsening respiratory status on admit, emergently intubated in ED. Transferred to ICU. Pt being proned. It has been 32 hours since admission, no nutrition support has been initiated yet. As the nurse, what would your initial recommendations be (remember to work within your scope).

A.

The patient is a 33-year-old obese female with asthma and diabetes mellitus. She is now presenting a fever and signs of dyspnea. The patient is found to have COVID-19 with acute respiratory distress syndrome. She was emergently intubated and transferred to the ICU after her respiratory status worsened. Also, she is being prone to improve oxygenation. It has now been 32 hours since admission, and no nutrition support has been initiated yet, which needs to be addressed immediately. 

B.

My initial recommendation is to immediately alert a physician or dietitian, making them aware that the patient, who has diabetes, has not had any nutritional support in 32 hours. and needs enteral nutrition before there are complications or malnutrition. Then, I would closely monitor and record the patient’s vitals, especially respiratory status. And since the patient has diabetes, glucose monitoring is important. 

Part 2:

About 7 days into admission, pt is found to have an ileus. Utilizing the nutrition support algorithm, what would this mean for the patients plan of care nutritionally speaking?

The development of the patient’s ileus should conclude in the pausing of enternal nutrition to prevent complications. It is important to closely monitor their fluid and electrolyte balance, and wait for the ileus to be resolved before slowly reintroducing it with small feeds.