Question

James Roberts, a 72-year-old African American male, is admitted to University Hospital with dehydration and acute respiratory failure. Mr. Roberts’ past medical history includes hypertension and chronic obstructive pulmonary disease (COPD). His current medications include clonidine (anti-hypertensive), prednisone (corticosteroid), and albuterol (bronchodilator). Since the death of his wife one year ago, Mr. Roberts lives alone and does not cook for himself. Per patient’s daughter, Mr. Roberts receives home-delivered meals from the food assistance program, Meals on Wheels. In addition to the one meal per day from Meals on Wheels, he relies on ready-to-eat foods, such as cereal, toast, canned fruit, cheese, processed deli meats (e.g. bologna), and snacks, such as potato chips and cookies. Due to ill-fitting dentures, Mr. Roberts does not eat fresh fruits and vegetables or unprocessed meats often. Mr. Roberts has been placed on a mechanical ventilator due to his respiratory failure. Dr. Connors, the physician, wants to start nutrition support in the next 24 hours. As his nurse, you listen for bowel sounds and they are positive in all four quadrants of the abdomen. The following information was recorded on admission: Height: 5’10" Weight: 155 lbs Usual weight (3 months ago): 170 lbs

Discuss the reasons for Mr. Roberts' increased protein needs.

Answer 1

Mr. Roberts' increased protein needs are due to acute respiratory failure, COPD, age-related protein requirements, and a diet low in protein-rich foods.

Step-by-step explanation:

Protein needs are increased in this case due to several factors:

1. The patient is experiencing acute respiratory failure, which can cause increased protein turnover and muscle breakdown. Protein is needed for the repair and regeneration of tissues.
2. The patient has chronic obstructive pulmonary disease (COPD), which can lead to muscle wasting and increased energy expenditure. Protein is necessary to support muscle function and respiratory muscle strength.
3. The patient is elderly and may have age-related protein requirements. Older adults may need more protein to maintain muscle mass and function.
4. The patient has ill-fitting dentures and consumes a diet that is low in fresh fruits, vegetables, and unprocessed meats. These foods are important sources of protein. Without them, the patient may not be getting enough protein in his diet.

These factors contribute to the increased protein needs of Mr. Roberts. Starting him on nutrition support will help ensure he receives adequate protein to support his medical condition and overall health.