careplan...nutrition imbalance on peg tube??

  1. on a careplan, if the pt. is on enteral feedings (using a peg tube) under nutrition, the pt. weights 80 lbs., can you have risk for imbalance: less than body requirements?? i'm not sure because they are having enteral feedings so obviously they are getting all the nutrition they need but she's so frail and tiny. i know there is a risk of something, but i'm not sure of what.

    any help??

    thanks!!!
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  2. 5 Comments

  3. by   Daytonite
    If 80 pounds is not the ideal weight for this patient, then he/she is not getting the correct amount of tube feeding. There also may be other metabolic factors that could account for a sudden weight loss, such as an occult infection process or some kind of healing going on requiring more energy expenditure. I don't have any references to back this up, but I have been told for some years (because I often worked in nursing homes as well as the acute hospital and saw this as well), that even though the enteral feedings were balanced nutrition, they were still not the same as the patient receiving "real" foods.

    In answer to your question, can you have risk for imbalance: less than body requirements? Yes. Look through the patient's history for evidence of other GI problems that could influence his/her ability to absorb nutrients or the presence of other medical diseases that could be causing the patient's metabolic rate to rise and require more food than is presently being given. I saw a good many elderly patients who were found to have widespread cancer, but it was only found when it was in the very last stages and the symptoms were pretty much hitting you in the face. If the patient is unable to tell you what aches, pains or discomforts they are having (as is typical in many nursing home patients) something occult may be going on that you and everyone else is unaware of. This is one of the challenges of working with this particular population of patients. Cancer and other diseases and illnesses take a lot of metabolic energy to sustain themselves. Cancerous tumors will suck the nutrients from normal cells to feed the aplastic growth first which is why cancer patients become so emaciated looking before they die. Infections and wounds are also similar, but not as aggressive as the cancer cells. However, if some unknown occult process is going on, is unknown to the caregivers, and the tube feeding is not adjusted for this, then the patient's weight is going to decline over time. Make sure you have checked the patient's weight history to see if this is a weight that the patient has sustained for some time or if it has recently declined to this number.
  4. by   MySimplePlan
    I can't believe I'm reading this....I just spent hours on this very same careplan last night and submitted it today. I used the very same diagnosis you are considering. I think my careplan came out very well, but we'll see what my CI has to say about that!

    My patient was just getting her PEG tube the morning I saw her. It was replacing an NG tube, which constantly became clogged, while the patient continued to lose weight. (70 lbs., down from 76 in June.) She is suffering from a progressive degenerative muscular disease, which usually advance to cancer or agressive immune disease. Pneumonia is a common eventuality as well, hence getting rid of the NG tube and risk for aspiration. Sadly, this lovely patient will not survive.

    The doctor's orders called for a diluted feedining initially, then 1200 cal/day, then 1500 cal/day if tolerated. I'm sure I will get it back tomorrow; let me know if you'd like some suggestions/comments my instructor made.
  5. by   MySimplePlan
    I can't believe I'm reading this....I just spent hours on this very same careplan last night and submitted it today. I used the very same diagnosis you are considering. I think my careplan came out very well, but we'll see what my CI has to say about that!

    My patient was just getting her PEG tube the morning I saw her. It was replacing an NG tube, which constantly became clogged, while the patient continued to lose weight. (70 lbs., down from 76 in June.) She is suffering from a progressive degenerative muscular disease, which usually advance to cancer or agressive immune disease. Pneumonia is a common eventuality as well, hence getting rid of the NG tube and risk for aspiration. Sadly, this lovely patient will not survive.

    The doctor's orders called for a diluted feedining initially, then 1200 cal/day, then 1500 cal/day if tolerated. I'm sure I will get it back tomorrow; let me know if you'd like some suggestions/comments my instructor made.
  6. by   MegNeoNurse
    How many cals are the tube feedings? I'm sure it is not what their daily requirement is. What are their residuals? Do they have good absorption? What do the stools looks like? They most definately can have nutrition imbalance and be on enteral feedings by way of a peg tube. Esp. if the pt. is 80lbs!
  7. by   Carlos Casteneda
    it occurs to me that most interventions need time, weekly weighing will inform of the trend which will indicate what the balance is, the potential risk remains but the regime can be adjusted .
    Also there may always be a potential risk, as tubes can block, infections can occur and the patient relies on others to completely meet nutrition/hydration needs. Best wishes Ju

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