During my Medical Nutrition Therapy 2 class senior year of undergraduate classes, we were assigned various case study worksheets to supplement the lecture material. This worksheet was on the topic of nutrition support.

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Student Name Chad Wessinger
UNIVERSITY OF PITTSBURGH
School of Health and Rehabilitation Sciences
Nutrition & Dietetics
NUTR 1632: Nutrition Therapy 2
Assignment: Nutrition Support (25 points)
Please type your answers.
1. You are assessing a 66-year old female who has had a CVA and now has severe oral phase
dysphagia. Per the speech-language pathologist, her dysphagia is likely a long-term
problem. She has lost significant weight over the last 3 months and is showing signs of
muscle wasting.
a. What is the indication to initiate tube feeding for this patient? (2 points)
Dysphagia, malnutrition
b. What type of enteral access route would you recommend? (1 point)
Nasogastric
2. What type of enteral formula would you recommend for the following patients?
a. A patient who is unable to eat due to dementia (1 point)=>
Standard polymeric formula
b. A patient with moderate malabsorption due to Crohn’s Disease (1 point)=>
Hydrolyzed formula
c. A patient s/p MVA (motor vehicle accident) with a severe head injury and multiple
bone fractures (1 point)=>
High nitrogen polymeric formula or consider Immune-modulating formula
c. A patient with severe hypervolemia and edema (1 point)=>
Concentrated polymeric formula
3. What TF administration method would you recommend for the following:
a. An independent patient living at home with esophageal cancer who has a G-tube
(1 point)=>
Bolus

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b. A hospitalized patient newly beginning TF due to poor appetite (1 point)=>
Continuous
d. A student attending high school who requires jejunal feedings (1 point)=>
Cyclic
4. What type of nutrition support would you recommend for the following patients? What
access route would you recommend?
a. A 33-year old male with a jejunal fistula. He has been having high output from the
fistula for the past 3 weeks with no sign of improvement. (2 points)
Parenteral nutrition, total parenteral nutrition
b. A 79-year old petite female who has a small bowel ileus s/p hip surgery. The surgeon
believes her bowel function should return to normal in a little over a week. (2 points)
Parenteral nutrition, peripheral parenteral nutrition
5. Write a specific tube feeding order to meet the nutritional needs of the following patient:
A 55-year old male who is s/p CABG (coronary artery bypass graft surgery). He is currently in
the ICU and has been placed on a ventilator. You have calculated his nutritional needs to be
2250 kcal, 105 grams protein, and 1900 ml fluid. Currently his GI tract is functioning well.
Please use the website for Abbott Nutrition or Nestle Nutrition (under “Course Documents”
=> “Website Resources” on Blackboard) to assist you with formula selection. You can also
use the online AND Nutrition Care Manual to obtain the kcal, protein, and fluid content of
the formula. Include in your answer the following:
a. Enteral access route you would recommend. (1 point)
Nasoenteric
b. Administration method you would recommend. (1 point)
Continuous
c. Brand name of the formula you are using. (1 point)
Nestle
d. Initial and goal TF order including recommended H2O flushes. Include how you would
advance from initial order to goal. State the total kcal, protein, and H2O that the goal

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formula will provide. Note: All mathematical calculations must be shown to receive
credit for your answer. (8 points)
COMPLEAT
Volume required to meet kcal needs: 2250 kcal / 1.06 kcal/ml = 2,123 ml of formula needed
Rate: 2,123 ml / 24 hrs = 88.5 = 90 ml/hr
Protein: 18% total kcal, 90 ml x 24 hrs = 2,160 ml, 2,160 x 1.06 = 2,290 kcal, 0.18 x 2290
kcal = 412 kcal, 412 / 4 = 103 g protein
Water: 85% total volume, 0.85 x 2.16 L = 1.84 L  1,840 ml free water in formula,
Fluid requirements: 1,900 ml, 1,900 ml – 1,840 ml free water = 60 ml additional water
needed to meet requirements, 30 ml water flush q 4 hrs
Initiation and progression: Rx start COMPLEAT at 30 ml/hr via nasoenteric route and
increase by 30 ml every 8 hours until goal rate of 90 ml/hr with 30 ml water flush q 4 hrs
which will provide 2,290 kcal, 103 g protein, and 1,900 ml water.