Question

1. Eugene is a 73-year-old man who weighs 168 pounds and is 5 ft 1O 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 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. Based on his age and activity, and considering his weight and health status, the dietitian has determined he needs:

2000 calories/ day and approximately 90 g protein per day to help maintain muscle mass

• 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 percutaneous endoscopic gastrostomy (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?

2. Samuel was recently discharged after being hospitalized for burns he suffered in an industrial accident that covered 18% TBSA. He is 38 years old, 5 ft 9 in tall, and currently weighs 134 pounds. His pre-burn weight was 150 to 155 pounds. He received 3 meals a day plus three high-protein shakes while in the hospital. He is motivated to regain weight, bur he refuses to drink any more of the shakes-they are too sweet and taste artificial. The dietitian told him he should be eating at least 2000 calories and include protein-dense foods at each meal and snack, but he lives alone and doesn't have the appetite for that amount of food. His usual pre-burn intake appears below:

Breakfast: Coffee with creamer; 2 doughnuts

Lunch: 2 hot dogs on buns, French fries; Diet soft drink

Dinner: Frozen pizza; Ice cream; Beer

• Evaluate Samuel's current BMI and normal adult weight. Calculate his weight loss percentage over the past month. Is it significant? What would be an appropriate goal weight?

• What specific strategies would you recommend he implement to improve his overall intake?

• Is 2000 calories an appropriate amount of daily calories for him? What sources of protein did he usually consume?

• Devise a sample menu for him that takes into account the calories and protein he needs, living arrangements, and lack of appetite.

Breakfast: Coffee with creamer; 2 doughnuts Lunch: 2 hot dogs on buns, French fries; Diet soft drink Dinner: Frozen pizza; Ice cream; Beer

Answer 1

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.

Specific liquids or foods allowed are:

GROUP		RECOMMENDED		AVOID
Milk and milk products		Milk (all types including buttermilk, soy, rice, almond and cow’s), milkshakes, pasteurized eggnog, smooth ice cream, frozen yogurt, custard, yogurt without fruit and pudding		All cheeses
Vegetables		All vegetable and tomato juice
Fruits		All juice and nectar
Breads & Grains		Cooked, refined cereals including cream of wheat, farina and cream of rice		All other cereals and breads
Meat & Meat substitutes		None
Fats & Oils		Butter, margarine, cream and oils		All others
Sweets & Desserts		Sherbet, sugar, sugar substitutes, hard candy, plain gelatin, fruit ice without added fruit pieces, honey and syrups		All others
Beverages		All
Soups		Broth, bouillon, smooth tomato soup and strained cream soups		All others

Sample 1-Day Menu for the Full Liquid Diet

Breakfast		Fruit Juice or Nectar Cream of wheat with margarine Milk Coffee or Hot Tea (with sugar, sugar substitute and/or cream as desired)
Lunch & Dinner		Fruit Juice or Nectar Strained Cream Soup Ice Cream or Sherbet Pudding Milk Iced Tea or Carbonated Beverage
Snacks		Milkshake or Liquid Nutritional Supplement such as Carnation® Instant Breakfast, Boost® or Ensure®