TITLE OF CASE
Nutrition Care Process in The Hemorrhagic Stroke, Hypertension and Stress Ulcer Patient
at National Brain Center Hospital, Jakarta - Indonesia
Rodlia,Anggita Marlida Septiani *)Dietitian
BACKGROUND
A Hemorrhagic stroke is a brain aneurysm burst or a weakened blood vessel. Only a few studies of hemorrhagic stroke complications refer to severe gastrointestinal hemorrhage (stress ulcers). This case study purpose to evaluate Nutrition Care Process in Hemorrhagic Stroke, Hypertension and Stress Ulcer Patient.
CLIENT HISTORY
Age : 56 years old
Sex : Male
Religion : Moslem
Occupation : Laborer
Education : Elementry school
History of the disease: Hypertension
Medical Diagnosi : Hemorrhagic Stroke, Hypertension, Stress Ulcer
ASSESSMENT
a.Anthropometric data:
Height 166 cm, weight : 62.7 Kg, BMI : 22.75 Kg/m2(Normal Weight)
b.Food/Nutrition-Related History
24- hours recall : NPO since admission, Naso Gastric Tube (NGT) : Gastric residual volume (GRV) 500 ml with black colour
Physician Therapy : Parenteral Nutrition via : Intravenous 41,6 ml/hours (drip 24-hours) (Clinimix), Sucralfate 15 ml (3 times/day), OMZ 40 g/day
NUTRITION DIAGNOSIS
Inadequate parenteral intake related to gastrointestinal bleeding as evidenced by parenteral intake 22.7% of energy recommended, Gastric residual volume 500ml with black colour.
OBJECTIVE OF MANAGEMENT & NUTRIENT PRESCRIPTION
Purpose: Increase Nutrition intake, target ≥ 80% recommended intake during 7 days.
Nutrition Prescription :
-Type : Total Parenteral Nutrition (Kabiven)
-Route: Intravenous
-Volume : 1440 ml/ 24 hours
-Nutrition Recommended: Energy 1782.6 kcal, Protein 66.8 g, Fat 59.4 g, and Carbohydrates 245.1 g
OUTCOME AND FOLLOW-UP
Day 5 :
GRV : No residual
Nutrition diagnosis: Inadequate enteral intake related to gastrointestinal bleeding as evidenced by enteral intake 22.4% of energy recommended
Nutrition Prescription : enteral via NGT. Volume :4 × 100 ml of whey protein oligomeric formula (Peptamen), Parenteral : Kabiven : 1440 ml/24 hours
Food Intake : Energy 78.5%, Fat 112.8%, and Carbohydrates 59.9%
Day 7 : Enteral Intake : 85% of Recommended Intake
DISCUSSION
In patients hospitalized for acute upper gastrointestinal bleeding due to an ulcer with high risk of rebleeding or with variceal bleeding it is recommended to wait at least 48 hours after endoscopic therapy before initiating oral or enteral feeding and they can be fed if they tolerated (Hebuterne and Vanbiervliet, 2011).
LEARNING POINTS/TAKE HOME MESSAGES
Suggestion : Multicenter Study Effect of Enteral Nutrition on Stress Ulcer Hemorrage.
