Nutrition Care

Conference

Chloe Seddon
November 2017
 Patient Description

❏ LR: 62 year old F

❏ Ht: 5’2”
❏ Wt: 244 lbs
❏ BMI of 44.6
❏ Class III obesity
❏ Resident at a SNF
❏ “steep decline” for 3 months
❏ Severe tremors for 6 weeks
❏ Weight loss
❏ Poor intake
Diagnosis

Failure to Thrive

❏ Defined in elderly persons as:

❏ Weight loss of >5%
❏ Decreased appetite
❏ Poor nutrition
❏ Inactivity
❏ Caused by chronic concurrent
diseases
 Medical History

❏ Endometrial cancer
❏ Hypertension
❏ Asthma
❏ Anxiety
❏ Severe MR
❏ Dysphagia

❏ PEG tube
❏ Weight loss of 30lbs in 3 months
❏ 90% of UBW per SNF
❏ Was consuming ½ PO, but poor to no PO intake for 3 months
 Medications

Drug/Generic Name Purpose Side Effect Nutritional Concerns

Anastrazole Chemotherapy hormone N/V May cause loss of appetite

Docusate sodium Laxative Diarrhea Monitor electrolytes

Metoprolol Beta blocker Dizziness May cause vomiting

Lovenox Treats DVT Dizziness May cause diarrhea

Piperacillin Antibiotic Fever May cause diarrhea

 Laboratory Data
Name of Lab Test Normal Range Patients Value Date Interpretation

Na 135-145 mmol/L 157 mmol/L 11/14/17 Inadequate PO intake

K 3.6-5.1 mmol/L 3.3 mmol/L 11/14/17 Possible dehydration D/T laxative use

Cl 100-111 mmol/L 30 mmol/L 11/14/17 Possible dehydration D/T laxative use

BUN 8-24 mg/dL 24 mg/dL 11/14/17 Renal labs WNL

Creatinine 0.6-1.2 mg/dL .7 mg/dL 11/14/17 Renal labs WNL

WBC 3.6-11.0 x 109/L 11.6 x 109/L 11/14/17 High due to infection

HGB 12-16 g/dL 12 g/dL 11/14/17 WNL

HCT 36-46% 41.4% 11/14/17 WNL

MCHC 32-36 g/dL 29 g/dL 11/14/17 Possible anemia

MCH 26-34 g/dL 25 g/dL 11/14/17 WNL

 Nutrition Assessment

❏ Pt is noncommunicative
❏ Wounds on thumbs from clenched hands
❏ High aspiration risk
❏ Severe tremors
❏ Nonambulatory
❏ No PO intake
❏ Receiving 720kcal via PEG at SNF

Nutrition Needs
❏ Calories: 1944kcal per mifflin
❏ Protein: 70g
❏ Carbohydrates: 243g
❏ Fat: 76g
❏ Fluid: 1944mL
 Diet Order

SNF: UCHC:

Regular diet Regular diet

Tube feed Tube feed

❏ Osmolite 1.2 @50mL/hr for 12 hrs ❏ Osmolite 1.2 @55 mL/hr continuous
❏ 33.5g protein ❏ 73g protein
❏ 720 kcal ❏ 1584kcal
❏ 492 mL H2O ❏ 1082 mL H2O
 PES Statement

Inadequate enteral nutrition infusion related to suboptimal tube

feed rate as evidenced by patient only receiving 1584 kcal.
 Intervention

❏ Goal: switch to Osmolite 1.5 @ 55 cc/hr 24 hours

continuous
❏ 1980 kcal
❏ 83g protein; 65g fat; 268g cho
❏ 1006 free H2O
❏ Flush 235mL q6h
❏ High aspiration risk: NPO
❏ Evaluation by speech for more definitive dysphagia
status
❏ Educate primary caregiver (aunt) on aspiration
risk/precautions
❏ Collaborate with nurse and physician on changing TF as
it has been suggested numerous times
Monitoring and Evaluation

❏ Monitor tolerance to tube feed

❏ J tube or bolus feeding may be more appropriate if rate/formula for PEG
isn’t tolerable
❏ Gradual weight loss
❏ Monitor electrolytes for improvement
❏ Monitor wound healing
❏ Evaluate aunt for knowledge of tube feed advancement and aspiration risk
 References

National Collaborating Centre for Acute Care (UK). “Enteral Tube Feeding in Hospital and the
Community.” Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral
Nutrition., U.S. National Library of Medicine, www.ncbi.nlm.nih.gov/books/NBK49253/.

“Difficulty Swallowing” Mayo Clinic, Mayo Foundation for Medical Education and Research, 15 Oct. 2014,
www.mayoclinic.org/diseases-conditions/dysphagia/basics/definition/con-20033444.

“Endometrial Cancer.” American Cancer Society, www.cancer.org/cancer/endometrial-cancer.html.

“Osmolite® 1.5 Cal.” a High-Protein Formula for Tube-Feeding, abbottnutrition.com/osmolite-1_5-cal.

Robertson, Russell G., and Marcos Montagnini. “Geriatric Failure to Thrive.” American Family Physician, 15
July 2004, www.aafp.org/afp/2004/0715/p343.html.
Questions?