Critical Care Case Study by Angelina Catania

angelinacatania — 2025-10-20 23:08:10 UTC

The patient is a 33 year old female with a past medical history of asthma, obesity, and diabetes mellitus. The patient also presents difficulty breathing and a fever. She was admitted with COVID 19 related ARDS. The patient is currently intubated, sedated and being is placed in the prone position in the ICU. It has been 32 hours since the admission with no nutrition support started. Patients who are critically ill and on mechanical ventilation have higher metabolic demands and are faced with an increased risk of malnutrition when nutrition support is not started within 24–48 hours. Given her obesity and diabetes, there needs to be a close monitoring of blood glucose levels. Early enteral nutrition is recommended to maintain gut health and reduce infection risk.

angelinacatania — 2025-10-20 23:13:34 UTC

As the nurse, I would advocate for the initiation of enteral nutrition as soon as possible. I would say to start this process within the next few hours since the patient is stable and has a functioning GI tract. I would notify the provider and dietitian that the patient has not yet received nutrition support. I would recommend placement of a feeding tube if one has not already been placed. I would also prepare for the start of continuous enteral feeding. I would also monitor for tolerance including gastric residual volumes, bowel sounds, and ensure that blood glucose is closely monitored due to her diabetes.

angelinacatania — 2025-10-20 23:19:58 UTC

About seven days into admission, the patient is now found to have an ileus. This means that her intestines are not moving properly and that they GI tract is temporarily nonfunctional. This condition makes enteral nutrition not the appropriate method, because feeding into the gut could cause distention, vomiting, or aspiration. Since the patient is intubated, critically ill, and unable to tolerate enteral feeding, she is now at a higher risk for further nutritional decline.

angelinacatania — 2025-10-20 23:24:36 UTC

Following the nutrition support, the patient should be transitioned from enteral nutrition to parenteral nutrition. This is since the GI tract is not usable. I would again notify the provider and the dietitian about the ileus and the need for PN evaluation. I would ensure that IV access is available for PN administration and continue to monitor her labs, along with her fluid balance. Once her bowel function returns, I would expect the team to reassess and transition safely back to enteral feeding.