2.  Patient: 40 y.o. WM  Dx: mandibular fracture, multiple facial fractures  PMH: pt denied any PMH  PSH: pt denied any PSH  MEDS: ◦ cefazolin - surgical prophylaxis ◦ dexamethasone ◦ Heparin ◦ morphine (PRN)  Anthropometrics: ◦ Ht: 5’11” (180cm) ◦ Wt: 165lbs (75kg) ◦ IBW: 172 (78.2kg) ◦ %IBW: 96% ◦ BMI: 23.15 (normal)  Labs: All pertinent labs are normal.

3.  Diet order: clear liquid diet for entire stay  Meal consumption: 100% for entire stay   PES STATEMENT: Biting/chewing difficulty related to mandibular fracture as evidenced by wired jaw and the need for a liquid diet.   Nutrition Interventions:  1. Ensure Plus vanilla or chocolate tid (low residue and allowed on clear liquid diet).  2. Brief education discussed with patient, wired jaw/fracture diet, how to liquefy food, and food supplement information.

4. SourceKcal requirementsProtein requirementsFluid requirements Union Memorial Hospital standard s Based on 90-120% IBW = 25-30 kcal/kg = 1875- 2250 Based on unstressed, well nourished clinical condition = 0.8-1.0 g/kg = 60-75 Based on 90-120% IBW = 25-30 kcal/kg = 1875- 2250 EALNo standard requirements for healthy adults. No evidence for a clinical or biochemical measure that best assesses hydration status ( grade III evidence). There are also no validated or established equations for determining fluid needs ( grade V evidence). NCMPatient not intubated, use Mifflin-St. Jeor (x1.2) = 2018 kcals/day From DRI and US Dietary Guidelines 2010 = 10-35% of energy intake = 50-177 g Recommended Dietary Allowance = 1 mL/kcal of intake = mL fluid required daily = 2018 ml

5. % IBWWeight range Loss from current weight % Loss in 1 month 80-90% IBW, mild malnutrition 62.5- 70.4 kg 4.6-12.5 kg6.1- 16.7%, severe 70-79% IBW, moderate malnutrition 54.7- 61.8 kg 13.2-20.3 kg17.6-27%, severe < 69% IBW, severe malnutrition < 54 kg21 kg28%, severe Study by Manus, et al Study by Guo, et al

6.  Homeless  Substance abuse  Poor family relations  No source of income  Compliance to nutritional care  Compliance to medical care

7.  Manzcs, R., Jr, DMD, Dodson, K., DMD, MPH, Miller, E., Jr, DMD, and Perciaccante, V., DDSJ. 2000. Nutritional Status of Substance Abusers With Mandible Fractures. Journal of Oral Maxillofacial Surgery, 58: 153-157.  Guo, C., Ma, D., Zhang, K., Hu, X. 2007. Relation between nutritional state and postoperative complications in patients with oral and maxillofacial malignancy. British Journal of Oral Maxillofacial Surgery, 45: 467–470.  American Dietetic Association Nutrition Care Manual. REE/EEE Calculator Equations, Ireton-Jones (IJEE) 1992 Equation. http://www.nutritioncaremanual.org/content.cfm?ncm_content_id=111029& highlight=mifflin%20st%20jeor http://www.nutritioncaremanual.org/content.cfm?ncm_content_id=111029& highlight=mifflin%20st%20jeor  American Dietetic Association Evidence Analysis Library Citations. What is the best equation to estimate fluid requirements in adults 19 years and older? http://www.adaevidencelibrary.com/conclusion.cfm?conclusion_statement_id =250894 http://www.adaevidencelibrary.com/conclusion.cfm?conclusion_statement_id =250894