NSG3TCN Lecture Notes - Lecture 7: Feeding Tube, Human Body Weight, Nbm Publishing
21 Jun 2018
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Enteral Workshop – suggested answers
Group 1 –Case study #1
Convenor:
Equipment required:
1) 55 copies of case study #1
2) White board/ white board marker
3) Calculator/pen
Related Learning Outcome:
- be able to plan an appropriate enteral feeding regimen
- understand the management of NGT feeding regimen
- be able to calculate the nutritional requirements for
differing medical conditions
- understand the nutrition management of refeeding
syndrome
Case:
Alice is an 80-year-old female admitted from a nursing home
a right sided stroke. She has been assessed by the Speech
Pathologist as not appropriate for oral intake and to be NBM.
1) Where will you get details regarding her anthropometry?
Nursing home, family, estimate
You establish that her weight is 45kg, and her height is 5ft 4”
2) Calculate her estimated energy and protein requirements
(include all working out)
Height 163cm Weight 45kg BMI 16.9kg/m2 (underweight++)
IBW 58kg!
Comment on BMI, use of actual vs ideal body weight and when each might be
used.
Energy
Harris benedict: 2741 + 1800 + 1255 – 1568 = 4228kJ/1010kcal
X AF + IF= 1.4
= 1414kcal/day (31kcal/kg)
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Schofield: 1.71 + 2.755 = 4.465MJ/1067kcal
X AF + IF = 1.4
= 1495kcal/day (33kcal/kg)
Protein:
1.0-1.2g/kg= 45-54g/day
3) Calculate an appropriate enteral feeding regimen
including starting regimen, water flush, and plan for
progression to goal rate.
NB: Consider intake hx, especially given weight ?refeeding risk
Refeeding risk:
- Depending upon recent diet hx, assuming no information commence
thiamine supplement prior to commencing enteral formula, baseline
EUC/CMP and supplement if required.
- Once position of tube confirmed by medical officer and documented ok to
start: 20mL/hr 1kcal/mL with fibre formula x 24/24, 50mL water flush 4/24
plus IVT. Organise daily bloods for EUC/CMP.
- Check bloods, if normal increase by ~250kcal per day (10mL/hr). If not,
keep formula at same rate and supplement where required.
- Continue this daily until goal 55-60mL/hour x 24/24. If NUMF @ 55ml/hr =
1320ml, 1320kcal, 53g protein (1.2g/kg), 57mmol Na/50mmol K+, 20g fibre
or if NUMF @ 60mL/hr = 1440kcal/6025kJ (32kcal/kg) , 58g protein
(1.3g/kg), 62mmol Na/55mmol K+, 22g fibre.
If patient was definitely not at risk of refeeding:
- Once position of tube confirmed by medical officer and documented ok to
start: commence 1kcal/mL fibre formula at 30-40mL/hr x 4/24, if tolerated
increase by 10mL ever 4/24 until goal rate reached (as above)
- Suggest 50mL water flush 4/24 = 1680mL total fluid/1450mL free water
(32mL/kg), may need to slightly increase upon review.
4) Upon review:
i) What are you checking?
Initial assessment/nutrition care plan remains appropriate, has clinical
condition changed etc.
ii) What do you need to look at (include chart
names)?
Med chart, fluid balance chart, bowel chart, BGL chart (if
appropriate), biochem, weight (if done)
iii) Who do you need to speak with?
Nurse, patient (if able)/family, doctor (if new issues)
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