Major Case Report

Kristina Markovic
Queens College Dietetic Intern
May 2017
Fast Facts

Resident is comatose
wikepedia

Resident is on NPO Tube Feeding

Rationale: Resident is comatose and has a
diagnosis of Gastroesophageal Disease (GERD)
Disease Description
 Gastroesophageal Reflux Disease
(GERD)
Decline in function of the lower esophageal
sphincter (LES)1
LES decline in functioning leads to gastric contents
from the stomach reflux back into the esophagus1
Symptoms:1
Heartburn
Cough
Eventual Ulcers
1. Merck Manual
 Medical Tests and Procedures

Confirming diagnosis1
Endoscopy
Ambulatory Acid Probe
Barium Swallow Test
Esophageal Motility Testing
Long Term
Surgical Therapy: fundoplication2

1. Merck Manual
2. https://gi.org/guideline/diagnosis-and-managemen-of-gastroesophageal-reflux-disease/
Comorbidities
Study of 670 patients
87.5% of patients had comorbidities
64.8% had 2+ comorbidities
Most common comorbidities
Hypertension (HTN) - 21%
Hypercholesterolemia/Obesity - 9%
Type 2 Diabetes - 5%
Depression - 4%
Nutrition Assessment
 Client History
39 year old Hispanic male
Advanced Directives
Full CPR
Hospitalization
...etc...
Admitting diagnoses (dx)
Open wound on the head, UTI, GERD, seizures, tracheostomy
status
Current dx
persistent vegetative state, GERD, conversion disorder with
seizures or convulsions, constipation, HTN, tracheostomy status
 Food-Related History
Nil Per Os (NPO)
Comatose
Enteral Nutrition via PEG tube
Chronic GERD/Comatose status
Jevity 1.5
1000cc/day starting at 4pm
80cc/hr
Flush 300cc before (AC), after (PC), 1PM, 1AM, 8PM
 Nutrition-Focused Physical Findings
Skin: 04/19/2017
Greenish section on tracheostomy site
Old surgical scar
Oral:
Upper R (1) and Lower R (32) missing; Upper L (16) and Lower L (17)
missing.
Medical Exam: 04/12/2017
Primary dx: anoxic encephalopathy
HEENT: old surgical scar
Skin: No edema
Mental Status: Impaired judgement
 Anthropometric Measurements
Height
66 inches

Weight
165.2 lbs.
BMI: 26.5
DBW: 101% (133-163 lbs)
Biochemical Data, Medical Tests,
and Procedures
Hemoglobin: 13.5g/dL
Hematocrit: 41%
Glucose: 105mg/dL
BUN: 13mg/dL
Creatinine: 0.40mg/dL
 Calculated Nutrient Needs

Kcal: 1980kcal

Protein: 75g

Fluids: 2250cc/day
Malnutrition Identification

No malnutrition present

101% DBW

Stable weight during the past 180 days

 PES statement
Inadequate oral intake related to comatose status/dysphagia as
evidenced by medical history forms and diagnoses.

Comatose/
dysphagia
 Medical & Nutritional Interventions
Medical
PEG tube placement
Nutritional
Provide order for Formula/solution: Jevity 1.5 1000cc/1500kcal
starting at 4pm with a flow rate of 80cc/hour
Provide feeding tube flush order: 300cc H2O before feeding (AC),
after feeding (PC), 1PM, 1AM and 8PM
Total Volume: 2500cc+med pass.
 References
Diagnosis and Management of Gastroesophageal Reflux Disease | American College of
Gastroenterology. (n.d.). Retrieved from
https://gi.org/guideline/diagnosis-and-managemen-of-gastroesophageal-reflux-disease/

Evidence Analysis Library. (n.d.). Retrieved from https://www.andeal.org/

Gastroesophageal Reflux Disease (GERD) - Gastrointestinal Disorders - Merck Manuals

Professional Edition. (n.d.). Retrieved from
http://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swa
llowing-disorders/gastroesophageal-reflux-disease-gerd

Moraes-Filho, J. P., Navarro-Rodriguez, T., Eisig, J. N., Barbuti, R. C., Chinzon, D., & Quigley, E. M.
(2009). Comorbidities are frequent in patients with gastroesophageal reflux disease in a
tertiary health care hospital. Clinics, 64(8), 785-790. doi:10.1590/s1807-59322009000800013
Thank You!