What recommendations can you make to the patient's critical care ...

[Redwolflake15]

What recommendations can you make to the patient's critical care team to help improve tolerance to the enteral feeding?
 
  What will be an ideal response?

Question 2

Determine your enteral feeding recommendations for Mr. Mahon. Provide a formula choice, goal rate, and instructions for initiation and advancement.
 
  What will be an ideal response?

[prumorgan]

Answer to Question 1

 Initiate EN early after admission to downregulate stress response and prevent bacterial translocation.
 Infuse EN distally in the GI tract (recommended NJ route)
 Choose an enteral formula that contains small peptides and MCT or a nearly fat-free elemental formula

Answer to Question 2

It is recommended that feedings be initiated in the jejunum (past the ligament of Treitz) and that either a chemically defined/fat-free formula or a small-peptide formula w/ MCT be delivered. One option is to use Perative, as it has MCT and consists of small peptides. The MCT will be better absorbed and the small peptides better tolerated in the jejunum.
Estimated energy requirements: 2345-2736 kcal/d 30-35 kcal/kg IBW/per ASPEN guidelines
Estimated protein requirements: 94-117 g pro/d (1.2-1.5 g/kg IBW)
Estimated fluid requirements: 2400-2700 mL

Perative: 1.3 kcal/mL 0.667 g protein/mL 79 water
2400/1.3= 1846 for total volume
1846 mL (total volume) / 24 hrs = 77 mL/ hr is goal rate
1846 mL x 0.0667 g pro/mL = 123 g pro

1846 x 1.3 kcal/mL = 2399 kcal
1458 mL water (Perative is 79 water)
1950 - 1327 = 623 mL free water
Initiate at 25 mL/hr, advancing 20-40 mL/hr every 6-8 hours until goal of 77 mL/hr is reached. This will provide 2399 kcal and 123 g protein.

[Redwolflake15]

Both answers were spot on, thank you once again

[prumorgan]

Great! Please up vote