For each of the PES statement, establish an appropriate goal (based on the signs and symptoms) and intervention (based on the etiology)

Question

What will be an ideal response?

Answer 1

• Inadequate oral intake related to oral motor dysfunction, limited food preferences, and need for prolonged feeding times as evidenced by reported energy intake of ~60% estimated needs and decreased growth velocity.
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- Goal: Meet estimated daily energy needs to promote adequate growth for age/condition. Start by increasing caloric intake by 10-20% daily. Promote weight gain to achieve a BMI tracking along percentile pt had been following before weight began to deviate from curve, ~9th percentile.
- Intervention: Educate family on ways to improve caloric density of foods/beverages. Consider adding an oral nutrition supplement of pt's choice (e.g., Boost Kid Essentials, CIB) to diet to increase energy intake.
• Altered nutrition related lab values (vitamin D) related to inadequate intake, increased vitamin D metabolism secondary to Phenytoin use, and decreased sunlight exposure as evidenced by 25-hydroxyvitamin D level (16 ng/mL) indicative of clinical deficiency.
- Goal: Meet RDA for vitamin D (15 mcg/day or 600 IU/day).
- Intervention: Provide patient with vitamin D supplement of 400 IUs/d.
• Inadequate fluid intake related to limited beverage intake between meals as evidenced by dry skin/mucous membranes, pt meeting ~70% estimated fluid needs per 24 hour recall, and elevated BUN.
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- Goal: Meet patient's estimated maintenance fluid requirements of 1562 mL/day.
- Intervention: Consume 400-600 mL additional fluid per day by encouraging pt to drink 8-12 oz of water throughout the day in between meals and increasing beverage intake at meals to 8 oz.Provide patient with 12 oz water bottle to use throughout the day.