Help with patient labs!!!! -Tube Feeding

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Im working on a project for school and I'm having a hard time wrapping my head around it if anyone can help. there's a 90 y/o patient with a stroke hx 2 wks ago, affected his rht side, expressive aphasia, dysphagia, etc. Getting Enrich 60 ml/hr for twelve hours from 8pm-8am (which seems wonky to me) and learning swallow with therapist during the day. His 0600 vitals are 160/88, pulse of 76, RR of 24, an temp of 98.8.

He has labs: Na+=148

Pot=5.0

Chloride=105

BUN=32

crt=2.1

Hgb=15.2

Hct=47%

Alb=3.0

Protein=4.7

What I can't find is anything on Enrich. Google searches have even tuned up empty. I can't find what the nutritional information on this stuff is so if anyone has an information, i would greatly appreciate it.

I also can't figure out what is going on her I initially thought since he is very elderly he may have been malnourished prior to stroke and could be experiencing refeeding syndrome? But usually potassium is low on that I thought and there is borderline high/normal here. His sodium is also a tad high so fluid volume should be ok, but he is hypertensive and tachypnic, so I'm all over the place I guess. His liver/renal labs are elevated, so maybe preexisting damage there, not able handle all the nutrition he is getting potassium, sodium, bulding up, kidneys not clearing like not clearning like normal. When sodium is retained from enrich, water is as well, leading to the high blood pressure?

I dont want all the answers I guess, we're allowed to talk it out with class mates, but I wanted to bounce it off some other people as well. Think aloud online I guess.

Thanks in advance :)

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I guess I kind of left out some other thoughts I want down as well lol

His album and protein are both low...could that suggest prior malnutrition? Leads me back to possible refeeding syndrome but if his liver is having issues and not synthesizing albumin...well. I don't know. I'm thinking in circles again. Maybe I'm making this too complicated and not seeing the big picture here?

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Specializes in SICU, trauma, neuro.

I'm a tad confused what the actual question is, and to be honest nutritional issues are not my strong suit. :o. I don't know what Enrich is either. It would help to know what kind of formula it is (high protein, renal, etc.) I would ask your instructor, if you're trying to determine if it's sufficient or not.

Generally if the Na level is high, the MD prescribes free water along with the feeding. It can be given by pump if the pump can be dually programmed, or the nurse can manually inject it through the PEG tube.

Also you mentioned the 8p - 8a schedule seems wonky. Nocturnal feeding allows the most freedom for the pt; he is tethered to the feeding pump while sleeping rather than while trying to live life.

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Looking at the labs - kidney labs are not ok (also K high perhaps due to that) and the high Hkt /Hgb indicate the blood is somewhat "thick" - perhaps part of it from dehydration but perhaps there is an underlying blood disorder.

When you look at the tube feeds - it is not unusual for people who do not have enough intake to get feedings at night and not during the day so they are hungry enough/more appetite to eat.

In any way - it looks like he might need some water with feeds - tube feed itself usually does not contain enough of it. A person can develop some kidney problems from dehydration....

If kidneys do not work sufficiently, TF needs to be adjusted to the right formula.

As a palliative nurse I right away think - does this 90 y old pat have advance directives???

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Specializes in Pedi.

Why is 12 hours of overnight feeds "wonky"? That's very common. The patient is hypernatremic which suggests a free water deficit. Why would high sodium lead you to believe that "fluid volume should be ok"? Sodium can be elevated in dehydration.

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Specializes in CTICU.

What is the question you are trying to answer?

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i found Enrich mentioned in an article on PubMed, but no where else. find out the manufacturer and go from there. patient may need digestive enzymes for the protein issue. and does need free water.

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Specializes in Emergency & Trauma/Adult ICU.

Enrich is probably the brand/trade name.

Look again at your labs, and consider dehydration.

What issue do you see with 8pm - 8am feeding? 8am - 8pm would definitely interfere with daytime activities and therapies.

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Specializes in Critical care.

Albumin has a half life of about 20 days, while prealbumin has a half life of 2-3 days. I was always told prealbumin is a much more accurate lab at determining the patient's current nutritional status.

Medscape: Medscape Access

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Specializes in Family Nurse Practitioner.

Based on what I have seen from book exerts online, Enrich is a lactose free, high fiber feeding solution. I don't think it is made anymore. Is this an actual patient or just an example from an assignment?

Your patient has electrolyte abnormalities from dehydration and renal failure. The tube feeding is probably not enough for him.

He is getting an average of only 30ml of fluid/hr. That is not enough. He needs water flushes to be added to his feeding regimen to correct the high sodium or his tube feeding formula should be changed. Once his kidney function normalizes, he can be switched to a high protein formula if needed.

He is definitely malnourished, but I've seen a lot worse. It is probably also from prior malnourishment which is common among the elderly, especially widowed elderly men.

There is no mention of weight gain which an important indicator as well.

Any past medical history?

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