Which of the following is NOT a step in integrated strategic change?  

Portal hypertension secondary to cirrhosis commonly results in the development of _______.

_________ is a precancerous condition which can progress to esophageal adenocarcinoma​. The risk factors for the condition include prolonged reflux disease, male, middle-aged, obesity, smoking, and family history.​

Growth of most Haemophilus species in culture is enhanced by:

Which of the following liver disorders would be reversible and require no medication if the insult to the liver is stopped?

In addition to the above information regarding K.R., the physician has ordered an exploratory laparoscopy of the upper gastrointestinal. The findings indicate K.R. has extensive gastric ulcers, and a biopsy has been done.K.R. was placed on a TPN ordered by the admitting physician to allow for gut rest. The RDN completed the NFPE and found K.R. had 2+ pitting edema and moderate muscle wasting.Based on ALL the information provided, what indications does K.R. have for a malnutrition diagnosis?

K.R.’s biopsy returned 3 days post-op and he does not have any signs of cancer. However, he does have Barrett’s Esophagus and extensive peptic ulcer disease. The ulcers are limited to his lower stomach and upper duodenum. He has a PEJ placed to allow for the esophagus to fully heal along with his extensive ulcers. The TPN will be discontinued in 4 to 5 days and K.R. will begin enteral feeding upon discharge from the hospital. K.R. is estimated to be on enteral nutrition for 6 weeks and then will transition to an oral diet. The RDN recommends K.R.’s enteral nutrition order to be Jevity 1.5 @ 55 ml/hour x 22 hours (1.5 kcals/ml; 63.8 g Pro/L; and 760 ml Free water per Liter). Calculate the TF order and type in the steps used to calculate the order to obtain total kcals and protein. Does the order meet K.R.’s current needs? Why or Why not?

Tell me what you would like to see in the next course? Be honest- remember I am here to help you succeed in an internship and as an RDN. What do you need more help with? What do you feel you have down that we do not need to continue to focus on for next semester? While I will not be teaching the course next semester, I will be developing it over the winter break for the adjunct to teach. So any feedback is appreciated.

Utilizing the previous exam case study- complete additional questions about the case. K.R. is a 60 y/o African American male who was admitted through the ER due to blood loss from a deep laceration on the arm. K.R. has a history of cardiovascular disease and hypertension. He is currently taking Coumadin and Lisinopril. K.R. arrived to the E.R. with complaints of shortness of breath and indicated he had cut his arm on the lawn mower blade. He could not stop bleeding and he became weak. K.R. received a blood transfusion and stitches in the E.R. and then was transferred to the floor for monitoring. K.R. was noted to have a current body weight of 155 lbs. and is 6’0”. K.R. states he has started losing weight over the last 3 months. He has noticed his pants are not fitting correctly and he is tightening his belt. K.R. states he is not hungry and usually weighs around 190 lbs. K.R. reports his bowel movements have changed and are very dark, blackish in color no matter what he eats. A Nutrition consult has been ordered by the admitting physician for a Coumadin education. 

Calculate K.R.’s kcals, protein, and fluid needs per day. Show your work for each calculation and answer by typing out the equation. Calculate the energy needs using the MSJE X 1.1 ActivityFactor X 1.2 Injury Factor BMR (men) = 10 X weight (in kg) + 6.25 X height (in cm) – 5 x age (in years) + 5 Calculate the energy needs using a comparable weight-based equation (25 kcals/ kg; 30 kcals/kg; 35 kcals/kg, etc.)Determine a calorie range. Calculate the protein needs based on all information provided in the case study. Remember, the RDA is 0.8g/kg of body weight.Calculate the fluid needs based on all information provided in the case study. Remember, the RDA is 1 ml per 1 kcal ingested. The RDN determined the TPN didn’t appropriately meet K.R.’s needs and RDN changed the order to better meet his needs. The RDN order: 500ml D40 + 500ml 10% plus 250 2.0% Intralipids.Calculate the TPN order. Be sure to show your work by typing out each equation with your answers. Also, include the total kcals, protein grams, and glucose utilization rate for the order.