Tube Feeding

Assignment #4:  Enteral feeding.  Documentation with ADIME

Your patient is admitted for inability to swallow.  Etiology of muscle weakness not clear; the patient reports about 4 weeks ago, he/she became aware of increasing choking while eating and eventual dysphagia to both liquids and solids – worse for solids. Had been able to tolerate liquids until newest symptoms began day and half ago. Patient began regurgitating foods and fluids and so presented to ER. The patient was admitted for work up.
Admitting diagnosis:  achalasia unknown origin.
ER Labs: Glu 100, Na 144, K+ 4.9 , BUN 27, Cr .8, Ca 9 Alb 3.9. Temperature  wnl.
Diet order:  NPO.   Patient was started on IV hydration with D5NS @ 100cc hr x 24hrs;   [NS= normal saline, D5 dextrose 5%]] while being worked up and iv famotidine.
Chart documentation indicates after rehydration there was a 10 lb weight loss. [Use your patient’s usual height and adjust the new ‘actual’ weight for the weight loss AS IF it were obtained from the Medical record and the diet history as if it were obtained from the patient.]
An NG tube is in place to begin feeding the patient. The MD of record asks for a nutritional assessment and recommendation for enteral nutrition support until etiology of problem is identified
Part I
Question 1                                                                     10
A.    Estimate your patients energy needs under these conditions; using MSJ and– document the factors you choose. And why
B.    Estimate his or her protein needs including gm/kg and why you chose this.
C.    Estimate fluid needs.
Question 2
D.    Using the NYU formulary that was uploaded, review the following formulas and chose which of the following would be appropriate for YOUR PATIENT, in view of his/her history and explain your choice.  Use the one you have chosen for the note you will write.                [10]
A.    Jevity 1.5
B.    Osmolite 1.5
C.    Peptamen 1.5
D.    Diabetasource AC

E.    Calculate the volume of feeding you would need to provide for your client’s needs. Document total cc’s, total calories, protein and fluid provided by the chosen formula as well as additional free water needed to meet needs.    10
F.    Choose method of feeding [bolus/gravity drip/ continuous] and explain why you made this choice.       10

Part II
•    USE ADIME format to document your assessment of this patient, as it would appear in the medical record. See an attached form to use as a guide.
•    Remember YOU ARE NOT answering questions in this section, rather writing up an assessment.

2.    Complete all sections of the ADIME
Assessment should include
•    Use your patient’s pertinent data and history            [5]
•    Evaluation of nutrition status –   [present]     [5]
•    Evaluation of nutrition risk  [5]
•    Estimation of energy/pro needs   USING MSJ/factors
•    What is needed/recommended/nutrition prescription in summary

3.    Nutrition Diagnosis in the [P. E. S. format]                            [ 12  ]
Nutrition Prescription: Summarize Suggested formula; total ml’s with calories, protein, fluid that it provides. Total fluid needs from feeding and additional water if necessary                                      [5]
[Evaluat the # of ml’s of formula recommend in relation to what is needed to meet RDI’s for vitamins.]    [3]

4.     INTERVENTION should include:                          10
a.     Recommended Formula and method
b.     How initiate feeds
c.     How to advance
c.      Goal: rate and time
d.     Additional fluid per shift or 24hr period needed.
5.     Monitoring and Evaluation                                       [5]
a.     What would you be monitoring and evaluating?

Additional question:  [not part of the note]             [5]
B     If patient were not able to resume PO within 6 weeks what would you recommend regarding how to best support this patient nutritionally?

6.        Extra credit  YOU MUST SHOW ALL YOUR WORK
a.     How many calories are being provided via the iv?        [1
b.     If the patient was to be switched to TPN for some unknown reason what would be your nutrition prescription of macronutrients [cho, pro, fat in grams]?  Show calculations                      [3]
Use your Handbook on N&D Standardized Language
OPTIONAL FORM
Nutrition Assessment:
Assessment:
Ht: ______ Wt:________________________ UBW: _______   %UBW: ________   -BMI: ________

Desirable body weight ____________________ %DBW_________________________

Wt Change: _________________   Time Frame: _______________ ? Intentional       ? Unintentional

Adjusted Body Weight: ____________________

______________________________________________________________________________________
Estimated Needs: ______________________kcals/d   __________________________kcals/kg

___________________ g pro/d   __________________________g/kg

Nutrition Status: ___________________ Pt @ nutrition risk ______________

2°:__
Nutrition Diagnosis:
Nutrition Prescription

Intervention

Monitoring and Evaluation: