Question

Location: Medical-Surgical Unit 2315

Report from day shift nurse:

Situation: Christopher Parrish is an 18-year-old male who was admitted at 1900 today. His mother visited him at his college dormitory and was very concerned with his health; he seemed weak and had lost weight since she last saw him. She took him to see his primary care provider, and the provider admitted him and has ordered a tube feeding. I placed an 8-Fr, 42-inch feeding tube in his right nares about an hour ago. The pump is in his room. He is up to the bathroom prn; otherwise bed rest.

Background: Christopher was diagnosed with cystic fibrosis as a child and has had frequent hospitalizations previously. He reports fatigue and has recently lost 6 kg (13.2 lb) after he registered at the local college and moved to live in a dormitory. Chris's mom was here earlier, but she is a single parent and has two younger boys, so she had to go home.

Assessment: Christopher is awake and alert. His heart rate and rhythm are regular at 80–85/min. Breath sounds are fine with a respiratory rate at 18/min. His color is a bit pale. Blood pressure is 118/78 mm Hg. He reports no pain and states he's not had much appetite the past few weeks. His belly is flat and nontender. Bowel sounds are normoactive.

Recommendation: Christopher is due for vital signs and assessment. The tube feeding just arrived, and you will need to start it on the pump. He needs 720 kilocalories over 8 hours overnight. His regular diet is high calorie, high fat, but he wasn't too hungry this evening; just had a bit of his chocolate shake. You will need to give his pancreatic enzymes orally before you start the tube feeding. You should also assess his diet and reinforce patient education on nutrition.

You just placed a feeding tube into the right nare of the patient. What is something you would do or suggest the MD order before starting the tube feedings?.

You have been ordered to reinforce patient education. Why is nutrition education important for this patient?

What lab(s) might the MD order to evaluate a patent's nutritional status?

Answer 1

The Nasogastric tube placement need to be confirmed with a Chest X-ray before starting the feeding.MD should order a chest xray.

• The chest x-ray view should be adequate – upper oesophagus down to below the diaphragm.
• The NG tube should remain in the midline down to the level of the diaphragm.
• The NG tube should bisect the carina.

Cystic fibrosis (CF) is a life-threatening disease that causes thick, sticky mucus to build up in the lungs and digestive tract. People with CF need to eat foods that are high in calories and protein throughout the day.

All people with CF should receive preventative or anticipatory nutritional counselling regardless of their age and clinical or nutritional status.

Early diagnosis gives the opportunity to prevent previously reported nutritional problems, including faltering growth, anaemia, vitamin deficiencies and hypoalbuminaemia.

Serum proteins (albumin, transferrin, prealbumin, retinol-binding protein) are perhaps the most widely used laboratory measures of nutritional status.pancreatic insufficiency, and screening for CF-related comorbidities should be done.