1. Sallie Smith is a 79-year-old retired teacher. She lived independently and was active in her church ladies’ group. Her daughter became concerned when Ms. Smith did not answer the phone for two days. When the daughter went to Sallie’s home, she found her on the floor. Ms. Smith was transported to the hospital by ambulance where a CT scan revealed she had suffered an embolic stroke. She has left hemiplegia and dysphagia and will be discharged to a skilled nursing center after PEG placement. Height: 64″ with current weight 150 lbs. Her weight has been stable for the past two years.

Ht- 64″ Wt – 150 lbs or 68 kgs IBW -120lbs or 54kg  BMI- 25.7 kg/m² (overweight)

Estimated energy needs:1350-1620 kcal (25-30) kcal)

Estimated protein needs:65-81g g protein (1.2-2.0g/kg)

Estimated fluid needs: 1350-1620 ml fluid (about 1ml /kcal)

tube feeding calculations  using  Osmolite 1.5

TF prescription and why this prescription.

Please help

ANSWER

In the case of Sallie Smith, a 79-year-old stroke patient who is about to undergo percutaneous endoscopic gastrostomy (PEG) tube placement, it is essential to calculate and prescribe the appropriate tube feeding regimen to meet her nutritional needs and support her recovery. Sallie’s clinical data includes a height of 64 inches (162.56 cm) and a weight of 150 lbs (68 kg), resulting in a BMI of 25.7 kg/m², which categorizes her as overweight. Her estimated energy needs are between 1350-1620 kcal per day, with protein needs ranging from 65-81g per day, and fluid needs of approximately 1350-1620 ml per day.

To ensure Sallie’s nutritional requirements are met while considering her overweight status and medical condition, a tube feeding prescription using Osmolite 1.5 can be an appropriate choice. Osmolite 1.5 is a high-protein, high-calorie enteral nutrition formula designed to support patients with increased nutritional needs, such as those recovering from medical conditions like strokes.

The tube feeding prescription for Sallie Smith would include

1. Caloric Intake: Since her estimated energy needs range from 1350-1620 kcal per day, a tube feeding regimen of 1500 kcal per day can be initiated initially to provide adequate nutrition without overloading her system. This allows for a gradual adjustment to her energy intake as her condition stabilizes.

2. Protein Intake: With estimated protein needs of 65-81g per day, it is advisable to provide 75g of protein daily through the enteral formula. This level of protein intake supports tissue repair and healing, which is crucial for stroke recovery.

3. Fluid Intake: Sallie’s estimated fluid needs are between 1350-1620 ml per day. It is essential to provide her with adequate hydration to prevent dehydration and maintain her overall health.

4. Osmolite 1.5: Osmolite 1.5 is chosen for its high caloric and protein content, making it suitable for Sallie’s nutritional needs during her recovery. It contains 1.5 kcal/ml and is specifically designed for patients with increased energy and protein requirements.

5. Feeding Schedule: Sallie should receive continuous tube feedings at a rate of approximately 62.5 ml/hour over 24 hours to meet her prescribed daily caloric and protein intake. This ensures a consistent supply of nutrients to support her recovery and minimizes the risk of complications.

6. Monitoring: Regular monitoring of Sallie’s nutritional status, weight, fluid balance, and any signs of intolerance or complications related to tube feeding is crucial. Adjustments to the feeding regimen should be made based on her clinical progress and nutritional needs.

In summary, the tube feeding prescription for Sallie Smith, utilizing Osmolite 1.5, is designed to provide the necessary calories, protein, and fluids to support her recovery from an embolic stroke while considering her overweight status. Close monitoring and adjustments to the regimen will ensure that her nutritional needs are met effectively, promoting the best possible outcome for her rehabilitation in the skilled nursing center.