Question

John recently suffered a gunshot wound to the abdomen and has undergone surgery. He is 37

years old, 6'0", and weighs 200 lbs. John is currently on a medical ventilator to help him
breathe.
1. Describe the metabolic response to injury (ebb phase and flow phase). If you do not
understand certain terms (such as hemodynamic instability), please attempt to do further
research

2. Explain what is occurring in the flow phase that requires increased calorie and protein needs.
3. Indirect calorimetry is not available to determine John's energy requirements, so we must use
the Ireton-Jones Energy Expenditure Equation. Calculate energy requirements for John using
Ireton-Jones Energy Expenditure Equation. Show calculations. Keep in mind all the factors that
are in John's case (ventilator dependent, weight, age, gender, trauma present).
4. Calculate a range of protein requirements for John. Show calculations.
5. John is having trouble consuming foods orally, but his GI system is functional. Name the type of nutrient delivery you believe John needs. Why is this delivery method suited for John?

Answer 1

John's metabolic response to his injury involves the ebb and flow phases, requiring increased energy and protein intake during recovery. Energy and protein needs are calculated using the Ireton-Jones Equation and body weight respectively, and enteral nutrition is recommended due to his functional GI system and difficulty with oral consumption.

Step-by-step explanation:

Metabolic Response to Injury and Nutritional Needs:

The metabolic response to injury such as a gunshot wound involves two phases: ebb phase and flow phase. The ebb phase is the immediate response following the injury where there is a decrease in oxygen consumption and cardiac output, leading to a reduction in metabolic rate. This phase is short-term and focuses on the body's initial survival. The flow phase follows and is characterized by an increased metabolic rate, hypermetabolism, and catabolism to fuel the healing process. This phase includes increased calorie and protein demands to support tissue repair, immune function, and recovery.

During the flow phase, John's body will have increased needs for calories and proteins because tissue regeneration, wound healing, and immune system activity are energy-intensive processes. Lack of indirect calorimetry means alternative equations must be used to estimate energy requirements. The Ireton-Jones Equation is one such method that considers factors like ventilator dependence, weight, age, and trauma presence.

Calculation for energy requirements using the Ireton-Jones Equation (for a ventilated, trauma patient):
Energy expenditure (kcal/day) = 1784 + 5(weight in kg) + 244(gender) + 11(age in years) + 292(trauma) + 851(temperature) - 432(ventilation status)

For protein requirements, the typical range is between 1.2 to 2.0 grams of protein per kilogram of body weight per day (g/kg/day) for critically ill patients. Specific calculations will reflect this range based on John's weight.

Enteral nutrition is recommended for John since he is having trouble consuming food orally but his gastrointestinal system is functioning. This method of nutrient delivery is suited for him because it is safe, cost-effective, maintains gut integrity, and utilizes the natural digestive process.

Answer 2

30 ibs that’s the answer

Hope this helped