Mr. H. is at postoperative day 7 after coronary artery bypass graft surgery. He has not eaten any significant calories since the operation. He does not like hospital food and has trouble chewing...

Mr. H. is at postoperative day 7 after coronary artery bypass graft surgery. He has not eaten any significant calories since the operation. He does not like hospital food and has trouble chewing because of poor dentition. Objective data include the following: height, 6 feet; weight, 135 pounds; and a history of a 20-pound weight loss in the last month. Laboratory data include a prealbumin level of less than 7.4 g/dL (normal values, 16.4-38 g/dL) and an albumin level of 1.6 g/dL (normal values, 3.5-5 g/dL); urine output has been adequate, and he has hypoactive bowel sounds.

Estimation of the patient’s calorie and protein needs are noted using data in Table 6-2. Based on the subjective and objective data presented, Mr. H. is a combination of moderately stressed to severely stressed. His kilocalorie intake requirements are 35 kcal/kg/day, and his protein requirements are approximately 1.5 to 2.0 g/kg/day.

Questions

1. What combination of assessment findings determines the patient’s nutritional status in this case study?

2. How do you justify the preferred route of intake in the critically ill patient?

3. What laboratory data best determine the patient’s state within a nutritional context?

4. What is the overall goal of nutritional therapy?

Table 6-2