1. What is the recommended daily intake of protein for an adult patient with a pressure ulcer? Explain the rationale for your answer. - The recommended daily intake of protein for an adult patient with a pressure ulcer is 1.25 to 1.5 g/kg of body weight. This is because protein is essential for wound healing, as it supports collagen synthesis, tissue repair, and immune function. Protein deficiency can impair wound healing and increase the risk of infection. 2. How would you assess the nutritional status of a patient with chronic obstructive pulmonary disease (COPD)? What are some nutritional interventions that can help improve their quality of life and reduce exacerbations? - To assess the nutritional status of a patient with COPD, you would use anthropometric measurements (such as body mass index, weight, and mid-upper arm circumference), biochemical tests (such as serum albumin, prealbumin, and transferrin), clinical signs (such as muscle wasting, edema, and oral health), and dietary intake (such as energy, protein, and micronutrient intake). Some nutritional interventions that can help improve their quality of life and reduce exacerbations are: increasing energy intake to meet their increased metabolic demands, increasing protein intake to prevent muscle loss and support respiratory function, providing frequent small meals and snacks to avoid early satiety and dyspnea, ensuring adequate hydration to thin secretions and prevent dehydration, and supplementing with antioxidants, omega-3 fatty acids, and vitamin D to reduce inflammation and enhance immunity. 3. What are the potential complications of parenteral nutrition (PN) in critically ill patients? How can they be prevented or managed? - Some potential complications of PN in critically ill patients are: infection (due to contamination of the catheter or the PN solution), metabolic disturbances (such as hyperglycemia, electrolyte imbalances, refeeding syndrome, or fatty acid deficiency), liver dysfunction (such as cholestasis, steatosis, or hepatic encephalopathy), and catheter-related problems (such as thrombosis, embolism, or displacement). To prevent or manage these complications, you would: use strict aseptic technique when handling the catheter and the PN solution, monitor blood glucose levels and adjust insulin infusion accordingly, monitor electrolyte levels and fluid balance and adjust PN composition accordingly, start PN gradually and increase slowly to avoid refeeding syndrome, provide adequate amounts of lipids and essential fatty acids to prevent fatty acid deficiency, monitor liver function tests and bilirubin levels and reduce PN infusion rate or switch to enteral nutrition if signs of liver dysfunction occur, and monitor catheter placement and patency and flush the catheter regularly to prevent catheter-related problems. 4. What are the indications and contraindications for enteral nutrition (EN) in acute care patients? What are some factors that influence the choice of EN route, formula, and delivery method? - The indications for EN in acute care patients are: inability to meet nutritional needs orally due to dysphagia, anorexia, nausea, vomiting, or altered mental status; presence of a functional gastrointestinal tract; and expected duration of EN longer than 7 days. The contraindications for EN in acute care patients are: intestinal obstruction, ileus, ischemia, perforation, or severe diarrhea; presence of a high-output fistula or severe malabsorption; hemodynamic instability or shock; and expected duration of EN shorter than 7 days. Some factors that influence the choice of EN route are: anatomy and physiology of the patient (such as the presence of gastric outlet obstruction or gastroparesis), risk of aspiration (such as the presence of