[Expert Solution]: PART FIVE: Parenteral Nutrition…

PART FIVE: Parenteral Nutrition Prescription Nutrition Assessment: L.M. is a 38-year-old woman with a history of pancreatitis hospitalized for severe dehydration due to hyperemesis gravidarum. She is 11 weeks pregnant and has not been able to tolerate oral intake for the past 10 days due to severe nausea and vomiting. Her current weight is 134 pounds compared to her pre-pregnancy weight of 140 pounds. She is 65 inches tall. She is started on IV fluids and parenteral nutrition support via PICC has been ordered. Nutrition Diagnosis: Inadequate energy intake related to compromised oral intake as evidenced by severe dehydration and significant weight loss of pregnancy. PART ONE: Determine the Parenteral Nutrition Prescription: Step 1: Determine a “dosing weight.” Step 2: Determine a kcal goal. Step 3: Adjust for activity and injury. Step 4: Calculate a protein goal. Step 5: Determine fluid requirements to provide a working volume for the parenteral solution. Step 6: Determine lipid concentration. Calculations for the Nutrient Prescription: Start lipids at 30% of kcalories. Determine kcal to be supplied from lipid: Multiply calories in nutrition prescription by 0.30. Determine grams of lipid by dividing kcal from lipid by 9. Divide lipid grams by total daily volume (fluid needs) in mL and multiply by 100 to determine % lipid. Step 7: Determine protein concentration. Calculations for the Nutrient Prescription: Divide protein needs (in grams) by total daily volume (in mL) and multiply by 100. Step 8: Determine grams of dextrose to meet remaining energy requirements. Determine dextrose concentration by dividing dextrose grams by total daily volume and multiply by 100. What is the final solution for macronutrients? Note % dextrose, lipid, and amino acids (protein) within total fluid volume. Step 9: Consider electrolyte needs. Step 10: Consider vitamin and mineral needs. Step 11: Write final parenteral nutrition prescription. Include rate in mL per hour over 24 hours. This is an EXAMPLE PRESCRIPTION. ALL of your nutrition Rx should look like this. You may not use this solution for your answer. 421 mL D50, 751 mL 20% AA, 350 mL 30% lipids, adjusted to 420 mL D50, 750 mL 20% AA, 350 mL 30% lipids, this provides a total of 2000 kcal (1000 kcal CHO, 300 kcal from AA, and 700 kcal from AA). Non-protein kcal = 1700, protein kcal = 300, protein g = 75 g