Critical Care Case Study by

krystleforemanpurn — 2025-03-17 16:00:54 UTC

Part 1: Pt is a 33 y.o. F with PMHx asthma, obesity, 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).

krystleforemanpurn — 2025-03-17 16:01:32 UTC

Even though the patient has been diagnosed with acute respiratory distress syndrome it is still possible to start enteral feedings with full goal rate which would need to be started soon as it is still within the 24-48 hour window. Since the patient is intubated an OGT or OJT will be used. I need to check the dietician's recommendations for the delivery method and type of tube feeding and in this case possibly will be disease specific due to patient Diabetes diagnosis and respiratory complications. Noticing the patient is obese, permissive underfeeding may also be recommended since over feeding could worsen their ARDS diagnosis. Since patient is proned, meaning they are lying on their stomach and will need to be flipped routinely, it is my job to monitor this patient closely for any signs of intolerance like vomiting for example and check in with the physician to see if they recommend a different lying position

krystleforemanpurn — 2025-03-17 16:02:20 UTC

krystleforemanpurn — 2025-03-17 16:03:24 UTC

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

krystleforemanpurn — 2025-03-17 16:03:45 UTC

krystleforemanpurn — 2025-03-17 16:04:12 UTC

Discovery of an ileus means the patient is most likely showing signs of intolerance such as abdominal pain, bloating, vomiting and/or constipation which are signs of an ileus. The physician and dietician would need to be consulted immediately as this means the patient is not receiving their complete nutritional needs due to a type of gastric obstruction. It would need to be discussed with the physician whether to switch the patient feeding from enteral to parenteral, which would be receiving nutritional needs outside of the intestinal tract and through the larger veins