Page 430 - Nutrition Essentials for Nursing Practice

418 U N I T 3 Nutrition in Clinical Practice

hypoglycemia. However, hypoglycemia symptoms have not been reported in studies of
abrupt discontinuation of PN in adults (Nirula, Yamanda, and Waxman, 2000).

When the patient is able to begin consuming food enterally (orally or by tube feeding),
the amount of PN is gradually reduced to compensate for calories consumed enterally. It is
recommended that PN be discontinued when enteral feeding provides more than 60% of
calorie goals (McClave et al., 2009).

HOW DO YOU RESPOND?

Why does it seem that “house” diets are not consistent with the Dietary Guidelines
for Americans for healthy eating (e.g., low in saturated fat, high in fiber)? The pur-
pose of the Dietary Guidelines for Americans is to prevent chronic diseases associated
with nutritional excesses, such as obesity, heart disease, and high blood pressure. The
goal of feeding hospitalized patients is to prevent or treat acute malnutrition associated
with illness or hospitalization. Therefore, the focus is not on avoiding excess but on
“getting enough.”

Is it good practice to color tube feedings? The Academy of Nutrition and Dietetics
Evidence Analysis Library (2012) states that blue dye should not be added to EN for the
detection of aspiration. The potential risks of using blue dye, such as skin discoloration,
contamination of dye, allergic reactions, and association with mortality (exact method
unknown), far outweigh any perceived benefit. Furthermore, the presence of blue dye in
tracheal secretions is not a sensitive indicator for aspiration.

My patient claims he can taste his tube feeding. Can he? Except for patients who
experience gastric reflux, patients cannot truly taste a tube feeding. However, the appear-
ance and aroma of the formula may influence the patient’s acceptance and perception of
palatability. If the formula’s appearance is offensive, cover the feeding reservoir or remove
it from the patient’s field of vision, if possible.

CASE STUDY

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 his-
tory 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 classi-
fied 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?