Question

Case Study #10 – Oral, Enteral, and Parenteral Nutrition

Eugene is a 73-year-old man who weighs 168 pounds and is 5 ft 10 in tall. He has had progressive difficulty swallowing related to supranuclear palsy. He has no other medical history other than hypertension, which is controlled by medication. He denies that the disease interferes with his ability to eat, even though he coughs frequently while eating and has lost 20 pounds over the last 6 months. He is currently hospitalized with pneumonia, and a swallowing evaluation concluded that he should have nothing by mouth (NPO). He has agreed to an NG tube because he believes the “problem” will be short term and he will be able to resume a normal oral diet after he is discharged from the hospital.

■ How many calories and how much protein does Eugene need? Is his weight loss classified as “significant”?

■ What type of formula would be most appropriate for him? How much formula would he need to meet his calorie requirements? How much formula would he need to meet his vitamin and mineral requirements?

■ What type of delivery would you recommend? What would the goal rate be?

■ If the doctor convinces him to agree to having a PEG tube placed, what formula and feeding schedule would you recommend for use at home? What does his family need to be taught about tube feedings?

Answer 1

since the patient is on NG TUBE feeding it is must to provide feed in full liquid or semi liquid form. Depending on the calories calculation choose the below listed items for your diet plan. Since we have fruits and vegetable juices the vitamin and mineral intake is taken care.

PEG stands for percutaneous endoscopic gastrostomy, a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach. PEG allows nutrition, fluids and/or medications to be put directly into the stomach, bypassing the mouth and esophagus.

Since in PEG only liquid diet can be given I have listed the full liquid diet plan for your reference:

Full Liquid Diet

A full liquid diet consists of liquids allowed on the clear liquid diet with the addition of milk and small amounts of fiber. The diet may be used for short term such as a transition step between the clear liquid and soft diet following gastrointestinal surgery or procedures. It may also be appropriate for those with certain swallowing and chewing problems. A well planned full liquid diet is adequate in calories, protein and fat but may be inadequate in vitamins (vitamin B12, vitamin A and thiamin), minerals (iron) and fiber.

Foods and liquids allowed on the full liquid diet includes all foods allowed on the clear liquid diet (popsicles, clear juice without pulp, plain gelatin, ice chips, water, sweetened tea or coffee (no creamer), popsicles, clear broths, carbonated beverages, flavored water and water) along with thin hot cereal (or gruel), strained cream soups, juices (including nectars), milkshakes, custard, puddings and liquid nutritional supplements.