case study

[xenomed]

hi everyone

would anyone please help me in this case study . thanks for your time.

case study:

you are caring mr dalton, 58 yrs old admitted to hopsital after suffering a cva. he is experiencing dysphagia and is unable to talke diet or fluids orally. a fine bore naso gastrictube was inserted yesterday for enteral feeding and x ray was take to check the correct tube placement. enteral feeds have now been running for 24 hrs. you answer mr dalton call bell and find him lying on bed complaining dyspnoea. he is pale and calmmy and you note that his respiratory rate is 26/min.

question 1.

what could be a possible cause of mr dalton current condition? provide a rationale for your answer.

question2.

identify 4 immediate nursing interventions that would be appropriate in this situation.

question 3

apart form respiratory complicaitons, describe other complication which may occure which a patient such as mr dalton is receiving enteral feeding.

looking forward.:)

[TakeTwoAspirin, MSN, RN, APRN]

What have you come up with so far?

[xenomed]

well

1. possible dislocation of enteric tubing, position of bed and aspiration into lungs.

may be enteric tube is disrupted .

2.Turn off the feeding apparatus to decrease the risk of aspiration, correct postion of the bed, notfiying medical team.

3. apart from respiratry complication

GI complicaiton like Nausea/ vomiting/ constipation due to decrease bowel motility/ Maldigestion/ Diarrhoea

[xenomed]

What else can I do for Immediate Nursing Interventions

[TakeTwoAspirin, MSN, RN, APRN]

Well, I would give some thoughts to the patient's LOC, given that he has a hx of CVA. I would also be interested in his blood glucose levels because these can be hard to control on patients with tube feeding. Check the patient's lung sounds, do you hear any congestion that might indicate aspiration into the lungs?

[xenomed]

I got your idea thanks:yeah:. Any paitent with decreased level of consciouness (which can be assessed by alert/ respond to voice/ respond to painful stimulus or unresponsive) has compromised airway. So it is necassary to check the Airway path ,breathing pattern or its rythm. Decreased level of consciouness is also caused by hypoglycaemia/ stroke/ and altered metabolic states (hypoglycaemia and hyperglycaemia). So it is advisable to check the Blood sugar level and intervene appropriately.

[EDRN-2010]

Well, I do not think you are typically supposed to shut off the enteral feeding IF it is running continuously (not intermittent) unless you know there is a problem with it and you have some dextrose to hang up in its place....

If someone is having trouble breathing and has an increase in respirations, what might that indicate as far as their fluid status? or a fluid shift???

Also, what are some potential complications that can occur after a CVA (that also fit the symptoms)?

I would assess his airway and make sure it is not an issue with the NG tube (Think about how you can you check placement aside from an x-ray???) How can you improve the breathing in a person who has increased respirations and having trouble breathing and has cold and clammy skin(positioning?)

When a person is getting enteral feedings especially with a NG tube something they are at risk for pulmonary aspiration, what are the signs of pulmonary aspiration...aspiration pneumonia?

What else can happen with enteral feedings? Think about what is in the enteral feedings and what is not in them....sodium, potassium, glucose, fluid imbalances, refeeding syndrome, N/V, diarrhea, constipation, malabsorption, maldigestion, tube cloggings...

Hope this gave you some ideas