Question

Case Study:

Mr. Larson, a postsurgical inpatient, recently had bowel resection for intestinal fistulas (abnormal passages between the intestines). He’s in some pain, and his appetite has been severely diminished over the past week; he has, in fact, refused some meals. Mr. Larson’s spouse expresses alarm over this and asks Denis, the postoperative care nurse, “Can’t we put him on IVs so he gets his nutrition?”

The surgeon determines that part of the cause of Mr. Larson’s reduced oral intake is the fact that he has developed short bowel syndrome; she places Mr. Larson on enteral tube feedings for the time being.

At first, Mr. Larson says nothing, but as soon as Dr. Harris leaves the room, Mr. Larson turns to Denis.

“Please,” he says. “I don’t want that. It stresses me out just thinking of you guys putting a tube down my throat! Let’s just not do that, okay? I can eat, like, Jell-O and stuff, okay? I like Jell-O. Okay?”

Denis starts to explain why additional nutrition is required.

“Okay, I get that,” Mr. Larson interrupts, trying to remain calm. “Okay. I know what we can do. Please. . . can’t you please just put me on IVs instead and keep that tube thing out of my throat?”

Questions:

1. How might Denis explain to Mr. Larson why it is preferable for him to receive EN rather than PN?

2. Mr. Larson’s spouse is understandably anxious about administering enteral feedings at home and asks about preventing bacterial infections from the feedings. What specific instruction can Denis offer?

3. In the next bed, Mr. Hashimoto, a postoperative patient of the same surgeon, has also had a bowel resection for severe ileus. During this surgery, cancerous lesions were discovered and removed. He is about to undergo intensive chemotherapy. Mr. Hashimoto, too, is experiencing difficulty eating. Overhearing Mr. Larson’s conversation with his spouse and the nurse, Mr. Hashimoto’s daughter takes Denis aside and asks, “Is my dad a good candidate for tube feeding?” Speculate on why Mr. Hashimoto, in contrast, is not a good candidate for enteral nutrition

Answer 1

1; ?it is recommended that you receive EN rather than PN. Because your GI tract is functional, accessible, and safe to use.

?so , EN is beneficial in maintaining the integrity of the gut as well.

✴️✴️ Indications of PN

✴️ unable to eat or drink

✴️ unable to absorb liquids and nutrients that are given through gastrointestinal tract

✴️ unconscious patient who is unable to absorb gastrointestinal Nutrients

✴️PN therapy requires a Central venous catheter indwells into the jugular or subclavian vein.Nurse should assist with this procedure for inserting a cvc .

2; ? do not hang feeding for longer than 4-8 hours

?keep ice in pouch of bag at all times while formula is running.

?Never add new formula to old formula

? Change tubing administration set daily.

?use closed feeding containers

3; Mr hashimoto is not a good candidate for EN due to:

?his intensive chemotherapy

?EN is contraindicated in patient's receiving intensive chemotherapy

AND

? Nutrition is the sum total of all the interaction that occurs between an organism and the food it consumes

? maintenance of good nutrition implies adequate intake of food

?it is very essential for the repair and healing of tissues

? requirement of nutrients varies from individual to individual and body to body .It depends upon the growth,age, activity level, climate, emotional status, illness, pregnancy etc

?hunger,thirst and safety are nature's first defence against malnutrition.

? psychosocial and cultural factors also influence the selection of food and patterns of behaviour associated with eating