As a takeaway from the information provided, there does not seem to be the need to alter her care plan at the very moment. Her stomach at this moment although sift is nondistended so it is not as of concern currently. Observation and her word of mouth shows there is no signs of discomfort or bloating. The goal rate for PN is going according to plan, MAP of 65 indicates stability specifically related to blood pressure. and this suggest that she is having the proper amount of nutrition. We will continue to monitor day to day and if changes need to be adjusted, we will change accordingly. Describe your plan for reassessment while the patient is on PN (5 points): Based on the information for Shannon I would say that she has a better abdominal status then when she came into the hospital. Its important to note that a soft non distended abdomen is a sign of improvement. She is operating at a target pace would be a demonstration of enhanced tolerance, a great sign. Again, she has no signs of dehydration. Again, reassessment should be taken day to day and if there are further signs of concern as stated the appropriate changes will be made. Answer the following short answer questions regarding PN management: 1. List 3 ways to control blood glucose levels with parenteral nutrition (1.5 points): -adjusting dextrose concentration in solution of PN -inulin administration - glucose monitoring on the regular 2. Today is day #2 of PN for Kyle. His potassium level is 3.2 (normal: 3.5-5.5) and his phosphate level is 2.0 (normal 2.5 to 4.5). PN is running at 30 mL/hr and the MIV is running at 90 mL/hr with 20 mEq of KCl. List 2 recommendations for correcting his labs (1point): I would give 2 recommendations for Kyle at this time. The recommendations would be suggested as followed, -Increasing the potassium in the concentration of the PN solution - additionally, you could add phosphate to the PON solution 1. Chloride and Acetate in the PN solution are used to management what (1 point)? They are used to maintain an acid base balance 2. List 3 ways micronutrients are provided in PN (1 point): -components of macronutrients through feeding themselves -vitamin and mineral additives Multivitamin and trace element additives 3. Scott’s has been on PN for 3 days and his serum magnesium level this am is 1.2 (normal range: 1.5-2.5). Based on the following information, what would you recommend (1.5 points)? PN day#1: Mg = 1.9 PN day#2: Mg = 1.5 PN day#3: Mg = 1.3 Based on the PN information Scott’s serum magnesium level has decreased slowly over the past several days. I think it would be best if we supplemented with magnesium concentration into the PN solution 4. What labs would you monitor to assess someone’s renal function (1 point)? For renal function common ways to track include creatinine (Cr), blood urea nitrogen (BUN) and glomerular filtration rate (GFR) 5. What micronutrients do you need to monitor closely with declining renal function - list 3 (1.5 points): Micronutrients that should be tracked include potassium, phosphorus and magnesium 6. List the 3 ways potassium can be provided in the PN. Today is day 4 for Tierney. Based on the following, what would you recommend based on her potassium level (1.5 points)? Labs: Na: 142 (135-145) K: 3.2 (3.6-5.5) Cl: 110 (101-111) HCO3: 18 (21-31) BUN: 22 (5-20) Cr: 1.1 (0.6-1.2) Glucose: 92 (70-99) Phos: 4.5 (3-4.5) GFR: 77 (normal range: >60) A Supplemental potassium can be provided in the PN... - To the base solution - Macronutrient components - Or separate potassium supplements PN Day # _________ Weight used for calculations: ________ kg All additives are based on amount per DAY