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Chapter 32: Nutrition

A 50-year-old woman with no significant past medical history has had total abdominal hysterectomy for fibroids yesterday. Her weight is 80 kg. On physical examination, the patient is noted to have clear breath sounds with a regular rate and rhythm, and her abdomen appears soft and distended. She has hypoactive bowel sounds. What is her ideal caloric intake?

A. 2400 kcal

B. 1600 kcal

C. 4800 kcal

D. 5000 kcal

A. 2400 kcal

Indirect calorimetry is the ideal way to determine energy needs, but when this is not available, 25 to 30 kcal/kg/d is used. This equation has an accuracy of 40% to 75%. Choices B to D do not adhere to this equation.

A 50-year-old woman with no significant past medical history has had total abdominal hysterectomy for fibroids yesterday. Her weight is 80 kg. On physical examination, the patient is noted to have clear breath sounds with a regular rate and rhythm, and her abdomen appears soft and distended. She has hypoactive bowel sounds. What is her ideal caloric intake?

What is the next step?

A. Provide no enteral nutrition and start parenteral nutrition.

B. Defer on any type of nutrition.

C. Start enteral nutrition within 24 hours.

D. Start enteral nutrition and parenteral nutrition until enteral nutrition meets more than 60% of daily requirements.

C. Start enteral nutrition within 24 hours.

It is advocated that EN should be started within 24 hours in postoperative patients. EN maybe deferred for up to 7 days in patients who are not postoperative (choice B) if they are classified as low nutritional risk via NRS-2002 (Table 32-3) or NUTRIC Risk Score (Table 32-4A-C). PN (choice A) is not considered within the first 7 days regardless of nutritional risk because of minimal benefit and a high risk of infections. Combination nutrition via enteral and parenteral routes (choice D) is not recommended if the patient can have enteral nutrition at full capacity.

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Table 32-3A. Nutritional Risk Screening (NRS-2002): Initial Screening
1 Is BMI < 20.5? Yes No
2 Has the patient lost weight within the past 3 mon?
3 Has the patient lad a reduced dietary intake in the past week?
4 Is the patient severely ill? (eg, in intensive therapy)

Yes: If the answer is “yes” to any question, the screening in Table 32-3B is performed.

No:...

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