Transitional Feeding Plan

Patient: W.W. 79-year-old male

Assessment:
Patient weighs 37.7 kg (83 lbs.), is 53 (160 cm) BMI: 14.7
Severe malnutrition, planned gastrectomy, chyle leak, AKI, GI
bleeding

Estimated Needs:
1130-1320 kcal (30-35 kcal/kg)
53-60 g protein (1.4-1.6 g/kg)
943-1130 ml fluid (25-30 ml/kg)

PES Statement:
Inadequate oral intake related to physiological causes
affecting ability to consume adequate energy via oral diet as
evidenced by poor intake >2 months, significant weight loss,
gastric outlet obstruction and NPO status with NG
decompression.

Nutrition Intervention Timeline:

- Day 1: TPN (Clinimix 5/15): initiate at 10 ml/hr titrate by
10 ml every 8 hours (refeeding risk) until goal rate of 50
ml/hr.
o Lipids (L20) MWF 225 ml (12-hour hang time)
o Provides: 1044 kcal, 60 g protein, 1200 ml fluid
- Day 4: Enteral (J-tube) Feedings initiated (Nutren, no
fiber): initiate continuously at 15 ml/hr increasing by 15
ml/hr every 8 hours to goal of 60 ml/hr
o Flushes of 30 ml every 4 hours
 o Provides 1440 kcal, 58 g protein, 1404 ml fluid
- Day 4: Decrease TPN rate by 5 ml/hr each time enteral
feeding is increased by 15 ml/hr.
- Day 5 (AM): Enteral feedings at 45 ml/hr, TPN at 30
ml/hr.
- Day 5 (PM): Enteral nutrition max rate reached, no new
bag to hang for TPN.
- Day 12 (AM): Enteral feedings held for vomiting,
distention and dilated loops of bowel.
- Day 12 (PM): TPN re-initiated at 25 ml/hr. Increase to
goal of 50 ml/hr after 8 hours.
o Lipids (L20) MWF 225 ml (12-hour hang time)
o Provides: 1044 kcal, 60 g protein, 1200 ml fluid
- Day 15: Enteral feedings initiated and held at 10 ml/hr
due to chyle leak (needs very minimal fat intake). TPN
continues at 50 ml/hr.
o Peptamen Intense, isotonic peptide based formula
with 30 ml flushes every 4 hours.
o Adds 240 kcal, 22 g protein, 202 ml fluid to current
TPN provision.
- Day 16: Peptamen feeding rate increased to 15 ml/hr.
- Day 17: Enteral feedings increased to 30 ml/hr, TPN
decreased to 35 ml/hr.
o 1509 kcal, 108 g protein, 1625 ml fluid daily.
- Day 18: Enteral nutrition increased to 40 ml/hr with goal
rate of 55 ml/hr not yet reached. TPN to discontinue at 6
pm.
- Day 19: Goal rate reached for enteral feedings. Pt
advanced to oral diet, adhering to post-gastrectomy diet.
Peptamen Intense to continue until oral intake improves
and is tolerated. Wean enteral feedings at that time.
o Patient discharged.