Raising protein rather than restricting it, this NS490 Unit 3 liver case workup sets every target from an estimated dry weight in a composite case of alcohol-associated hepatitis. Searches like "ns 490 unit 3 assignment example", "ns490 unit 3 sample" and "ns490 unit 3 example" land here.
What a finished NS490 Unit 3 liver case workup looks like
Its case section records a measured weight of [81] kg with moderate ascites, a Maddrey score of [38], raised bilirubin and INR, grade 1 encephalopathy following [four] constipated days, and a diet history of [one] meal and [several] sweetened coffees a day. A dry-weight box subtracts an estimated 10 percent for ascites, giving 72.9 kg, and states that the subtraction is a convention rather than a measurement. Targets follow from that figure: 35 kcal/kg, about 2,550 kcal, and 1.2 to 1.5 g/kg protein, or 87 to 109 g. A section on the protein proposal answers the chart note directly. The plan adds a late-evening snack, sodium near 2 g, and thiamine before carbohydrate, the last flagged as a medical order to request.
How a NS490 Unit 3 example is structured
The workup is ordered to answer one question the chart raises: should protein be cut because he became confused? Assessment comes first and makes the weight problem explicit, since ascites inflates the scale and every per-kilogram target inherits the error. The encephalopathy section lists the precipitant the case supplies, constipation, and treats it as a medical matter before any dietary one. The protein section then states the position of ESPEN's liver disease guidance, that restriction is not recommended in encephalopathy and that 1.2 to 1.5 g/kg supports muscle, and it names vegetable and dairy protein as options if tolerance becomes a real problem. The appetite section follows, with meal frequency, a late-evening snack to shorten the overnight fast, and a threshold at which enteral feeding would be proposed to the team. Monitoring closes the paper.
A weight the scale overstates
Moderate ascites adds kilograms that are not tissue. The dry-weight box shows the 10 percent convention applied, says where the convention comes from, and uses the result for every target that follows.
Confusion with a named precipitant
Four days without a bowel movement is recorded as the likely trigger. The workup leaves treatment of that trigger with the medical team and refuses to let a dietary change stand in for it.
The chart note answered
Restricting protein would speed the muscle loss he already shows. The workup cites ESPEN's liver disease guidance against restriction and keeps vegetable and dairy protein in reserve if intolerance becomes real.
Shortening the overnight fast
A late-evening snack with carbohydrate and protein reduces the long fast that a failing liver handles badly. Timing and contents are specified, along with the reason for each.
Sodium without starving him
About 2 g of sodium supports the ascites plan, and the workup warns that stricter limits make food unpalatable for a man already eating one meal a day.
When oral intake is not enough
A bracketed threshold of intake against goal, held for a stated number of days, triggers a proposal for tube feeding to the team. The decision itself is recorded as theirs.
Where marks go in NS490 Unit 3
Accuracy of the liver-specific targets tends to carry the largest share of a workup's marks, with complications, evidence and feasibility behind it. Target marks depend on computing from a stated dry weight rather than the swollen one, which is where many liver papers go wrong before any nutrition is discussed. Complication marks come from treating the precipitant of encephalopathy as medical while still answering the dietary question directly. Evidence is a current guideline named at each target. Feasibility shows in a snack, a meal pattern and a sodium level a man with no appetite could meet. Common deductions include protein restriction presented as standard care, targets calculated on actual weight with ascites, sodium limits so strict they cut intake further, and thiamine forgotten in a patient with an alcohol history.
Get a NS490 Unit 3 example written to your instructions
Cirrhosis from another cause, a transplant evaluation or thinner labs may stand in for this patient in NS490 Unit 3. Forward the case notes, any guideline the course specifies and the rubric. The workup comes back with a dry-weight estimate shown, targets computed from it and every medical decision left with the team. Allow 24-48h; the first custom sample costs nothing.
NS490 Unit 3 questions, answered
How should dry weight be estimated with ascites?
Most course texts use a convention that subtracts a set percentage of measured weight depending on how much fluid is present, often 5, 10 and 15 percent for mild, moderate and severe ascites, or a post-paracentesis weight if one is recorded. Name the method, cite it, and state that the result is an estimate. A target calculated on the swollen weight will be too high.
Is branched-chain amino acid supplementation worth mentioning?
Briefly, where the case supports it. Guidance allows it for people who genuinely cannot tolerate enough protein from food, and some evidence links it to fewer complications. A paper that mentions it as an option for intolerance, with a citation, shows awareness without overstating what the supplement does for a typical patient.
Should the workup address alcohol use?
Yes, as it bears on nutrition: thiamine and folate status, the energy he drank rather than ate, and the likely effect of stopping on appetite. Treatment of alcohol use itself sits with the medical team and specialist services, and the workup should name that referral rather than attempt it.