| Course | NS490 Medical Nutrition Therapy II |
|---|---|
| Unit | Unit 7 |
| Paper type | Critical care case study |
| Length | About 1,120 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | BS in Nutrition Science |
| Updated | October 2026 |
Free sample paper for NS490 Unit 7
Four Rewrites in Eight Days: A Unit 7 Critical Care Case Study of Feeding a Woman With ARDS on Propofol
[Student Name]
Purdue University Global
NS490: Medical Nutrition Therapy II
Unit 7 Critical Care Case Study
[Instructor Name]
[Date]
The patient and all values are composite; the two critical care nutrition guidelines and the earlier nutrition support guideline cited are real; the plans are course examples, not orders.
Case Presentation
Karen, 48, drives a school bus. She came into the medical ICU with severe influenza pneumonia that progressed to acute respiratory distress syndrome. She was intubated on day 1 and started on a norepinephrine infusion for low blood pressure and propofol for sedation. She has no diabetes or kidney disease. Her height is 168 cm and her admission weight 70 kg, with a BMI of 24.8.
Day 1: Hold and Prepare
Plan 1. On day 1, Karen's norepinephrine dose was rising and her blood pressure unstable. Critical care guidelines favor early enteral feeding, within the first two days, for patients who cannot eat, but advise caution or delay while shock is uncontrolled and vasopressor doses are escalating, because the gut may be poorly perfused (Singer et al., 2019). The plan on day 1 was to place an orogastric tube, confirm its position, and hold feeding until the vasopressor dose stabilized.
Energy estimate: 12 to 25 kcal per kilogram in the first week, following the 2022 critical care guideline, which lowered its energy recommendation because of uncertainty about harm from higher early intakes (Compher et al., 2022). 12 times 70 equals 840 kcal; 25 times 70 equals 1,750 kcal.
Protein estimate: 1.2 to 2.0 g per kilogram: 84 to 140 g per day.
Day 2: Start, Counting Propofol
Plan 2. By day 2 her norepinephrine dose was stable and falling. Enteral feeding started with a standard high-protein formula, 1.0 kcal and 62.5 g protein per liter, at 20 mL an hour.
Propofol is a lipid emulsion providing about 1.1 kcal per mL. At 20 mL an hour, 20 times 24 equals 480 mL, and 480 times 1.1 equals 528 kcal a day, all from fat.
Propofol supplied 528 kcal a day before a single milliliter of formula, which meant that an energy goal set without it would overfeed her while still leaving her short of protein.
Goal for the first week: about 1,400 kcal, near the middle of the range. Formula energy needed: 1,400 minus 528 equals 872 kcal, or about 870 mL a day, roughly 36 mL an hour. Protein from 870 mL of the formula: 0.87 times 62.5 equals 54 g, well below the 84 g minimum. A protein modular of 30 g a day was added, bringing protein to 84 g.
Day 4: Prone Positioning and More Propofol
Plan 3. On day 4 her oxygen levels worsened, and the team began prone positioning for 16 hours a day. Her propofol increased to 30 mL an hour to keep her comfortable, which is 30 times 24 times 1.1, or 792 kcal a day.
Enteral feeding can usually continue during prone positioning, with the head of the bed raised in a reverse tilt and attention to vomiting or high residuals (Singer et al., 2019). The plan continued feeding at a reduced rate. Formula energy needed: 1,400 minus 792 equals 608 kcal, about 25 mL an hour. To keep protein near goal, the formula was changed to a very high-protein, lower-energy product and the modular increased, keeping protein at about 90 g a day.
Triglycerides were checked, since high-dose propofol can raise them; they were 210 mg/dL, within an acceptable range.
Day 7: Propofol Stops
Plan 4. By day 7 her oxygen improved, prone sessions ended and propofol was replaced with a different sedative that supplies no calories. The lipid energy from propofol disappeared overnight. Without a change, her intake would have dropped by nearly 800 kcal.
The plan increased formula to full goal for the recovery phase. The 2016 nutrition support guideline suggested advancing toward goal energy after the first week in patients who are improving, with protein at the higher end of the range (McClave et al., 2016). Goal energy was raised to about 25 kcal per kilogram, 1,750 kcal, and protein to 1.5 to 2.0 g per kilogram, 105 to 140 g. The very high-protein formula at 60 mL an hour provided most of this, with the modular continued.
Day 8: Looking Ahead
On day 8 the team began planning extubation. Nutrition planning turned to the swallow evaluation that would follow, the risk of reduced intake after extubation, and the likelihood of oral supplements during recovery.
Why Protein Stayed the Priority
Across every rewrite, energy moved up and down while protein was held near goal. Critically ill patients break down muscle quickly, and a woman lying sedated and prone for days loses strength she will need to breathe on her own and to walk again. Energy can be supplied from several sources, including propofol, but protein comes only from what the team delivers, so a falling formula rate without a modular would cut protein exactly when it matters. That is why each plan began by asking how much energy the propofol supplied and then built the formula and modular around the protein target, rather than starting from energy and accepting whatever protein followed.
Communication at the Bedside
Each rewrite depended on hearing about changes as they happened. The dietitian joined morning rounds, asked the nurse about propofol rates and feeding interruptions, and left a short note after each change explaining the new rate and why. When propofol was stopped on day 7, the overnight nurse paged the dietitian, which is why the increase happened the same morning rather than days later.
Monitoring Across the Eight Days
Daily: feeding volume delivered compared with ordered, propofol rate, glucose, electrolytes including phosphate, and gastrointestinal tolerance. Twice weekly: triglycerides while on propofol. Weekly: weight, interpreted with caution because of fluid shifts.
Discussion
The four plans followed four changes: shock, propofol, prone positioning and the end of propofol. None of these were nutrition decisions, but each changed what nutrition needed to do. A plan written on day 1 and left unchanged would have underfed her protein early and dropped her energy sharply on day 7. The skill the case teaches is less about calculation than about watching the medicine list and the bedside every day.
Limitations
Energy estimates in critical illness are uncertain, and indirect calorimetry would have been preferable if available. Guidelines differ on the exact energy targets in the first week. Delivered volume often falls short of ordered volume because of procedures and interruptions, which the plan monitored but could not fully prevent.
References
Compher, C., Bingham, A. L., McCall, M., Patel, J., Rice, T. W., Braunschweig, C., & McKeever, L. (2022). Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. Journal of Parenteral and Enteral Nutrition, 46(1), 12-41. https://doi.org/10.1002/jpen.2267
McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., Gervasio, J. M., Sacks, G. S., Roberts, P. R., & Compher, C. (2016). Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient. Journal of Parenteral and Enteral Nutrition, 40(2), 159-211. https://doi.org/10.1177/0148607115621863
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Montejo, J. C., Pichard, C., Preiser, J.-C., van Zanten, A. R. H., Oczkowski, S., Szczeklik, W., & Bischoff, S. C. (2019). ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition, 38(1), 48-79. https://doi.org/10.1016/j.clnu.2018.08.037
What the NS490 Unit 7 assignment asks for
For the seventh NS490 unit, the prompt sets a critically ill patient whose condition changes over several days and asks for a nutrition plan at each stage. Students should explain when to start feeding and when to wait, using critical care guidelines. Energy and protein targets for the first week need a source and a stated weight. Count non-nutrition calories, such as propofol, before setting the formula rate. Each change in the patient, such as positioning, sedation or a new route, should produce a revised plan with the reason. Protein deserves special attention because critical illness breaks down muscle quickly. Describe how the plan is communicated to the team at the bedside. Monitoring should cover tolerance, glucose and electrolytes. A discussion section connects the case to the evidence. A finished case study at this level tends to reach five to seven pages, with APA 7 throughout.
How this NS490 Unit 7 example is built
The study opens with the patient's admission, intubation and vasopressor needs. Day 1 holds feeding while shock is unstable, citing guidance on caution with rising vasopressor doses, and sets a first-week energy range of 12 to 25 kcal per kilogram. Day 2 starts a high-protein formula and calculates propofol energy, and the highlighted sentence explains how that changes the math. A 30 g protein modular brings protein to the minimum. Day 4 adds prone positioning and a higher propofol rate, so the formula rate is lowered again. Day 7 stops propofol and the formula rises. Day 8 looks ahead to extubation. A section explains why protein stayed the priority throughout. Bedside communication, monitoring across the eight days, a discussion of the guidance and limitations close the study.
Reading the NS490 Unit 7 grading rubric
Critical care case studies are graded on clinical reasoning across time as much as on single calculations. Each plan change must follow from a change in the patient, with a reason stated. The decision to hold or start feeding should rest on current guidelines. Counting propofol or other calorie sources shows the attention to detail this unit rewards. Protein targets and how they are met earn significant points. Monitoring must be specific to the intensive care setting. The communication section shows teamwork. The discussion should connect choices to evidence and admit uncertainty where guidance differs. A clear day-by-day structure helps the reader follow. APA 7 and current critical care guidelines finish the rubric, and citing both the European and American guidance shows awareness that they differ.
Common NS490 Unit 7 mistakes, and how to avoid them
Critical care papers often set one plan on day 1 and never revise it, which misses the point of the unit. Many forget propofol calories, so the patient is overfed on fat while short of protein. Some start feeding during unstable shock without addressing the risk. Energy goals for the first week are sometimes set at full needs without discussing the guidance on lower early intake. Protein modulars are missed when the formula alone falls short. Monitoring sections copy a ward list rather than an intensive care one. Discussion sections summarize instead of reasoning. When your case runs over several days and the plan keeps changing, our writers can prepare the case study day by day from your own scenario.
Get an NS490 Unit 7 example written to your instructions
Trauma, sepsis or pancreatitis may replace respiratory failure in your NS490 Unit 7 case, with different days and data. Pass along every dated value in the case, the energy method your section expects and the rubric. Each day's plan is recalculated from its own inputs with sedation counted, back within 24-48h, and a first custom sample carries no cost. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NS490 Unit 7 questions, answered
Should the case study aim for full energy needs in the first week?
Current critical care guidance generally favors lower energy delivery in the first several days, within a stated range, while protein is pushed toward its target. The exact figures differ between ASPEN and ESPEN, so quote the one your course uses and cite it. Full goal feeding from day 1 in someone at risk of refeeding will usually draw a comment.
How are propofol calories calculated?
Multiply the hourly rate in milliliters by 1.1 kcal per milliliter, the energy of its lipid carrier, then by the hours infused. The result is subtracted from the energy goal before the formula rate is set. Rates change often in intensive care, so recalculate whenever the case gives a new rate.
Where can I find a free NS490 Unit 7 sample paper?
A complete NS490 Unit 7 critical care case study is on this page, rewriting the nutrition plan four times over eight days for a woman with ARDS on propofol.
How was the formula rate set in the NS490 Unit 7 sample?
The first-week goal of about 1,400 kcal had the 528 kcal from propofol subtracted, leaving about 870 kcal from formula, or roughly 36 mL an hour. A 30 g protein modular then brought protein to 84 g.
Which energy range does the NS490 Unit 7 sample use in week one?
It uses 12 to 25 kcal per kilogram, following the 2022 American critical care guideline that lowered early energy goals. For a 70 kg patient that range is 840 to 1,750 kcal a day.