Norzainora Hamsah. 1, Nor Adlina Zakaria .1
1. Department of Dietetics and Foodservices, Hospital Kuala Lumpur
Background : Transitional feeding describes the process by which a tube-fed patients returns to an oral diet. The overlapping of one dietary regimen with another is essential for successful transitioning.
Client history : A 33 years old man, underlying of germ testicular tumour, DM, HPT, CKD was transferred to GICU. Patient was diagnosed with sepsis secondary to nosocomial infection. Patient on nasogastric (NG) tube feeding with energy dense formula, 100ml 3 hourly.
Assessment : Patient is obese with BMI 30.7kg/m2. Patient was ventilated and on regular dialysis. Patient was extubated on Day 4 and allowed for soft diet with NG tube feeding. On Day 10, patient’s protein intake was insufficient due to refuse to eat and was diagnosed severe depression. Meanwhile, tube feeding regimen was not comply.
Nutrition Diagnosis : Inadequate protein intake related to insufficient provision protein due to poor oral intake and depression with lack of NG tube feeding provision as evidenced by protein intake 83 g/ day (72% from requirement).
Nutrition Intervention : Using Ireton –Jones equation, patient required 1434 kcal and 92-115g protein/day. Patient was put with mixed porridge and 100ml 3hourly energy dense formula 1.6 kcal/ml via NG tube.
Monitoring & Evaluation
Nutrition Monitoring and Evaluation : Patient was encouraged to optimize his oral intake by taking orally small, frequent energy dense meal. Caregivers have been advised to assist patient in order to improve his dietary intake by providing additional options of outside food choices and given emotional support during admission. Staff nurse was emphasized to comply to feeding regimen as prescribed by Dietitian.
Lesson learnt : Frequent monitoring by Dietitian is important to maintain adequacy of nutrient intake. The total time to wean from tube feeding to oral feeding is vary between patient. Effective communication with the nurse and patient’s caregiver is important to ensure positive nutrition outcomes.