Answer to Question 1
Initially, Ms. Watson will be placed as NPO for 1-2 days and then begin oral intake with clear liquids.
Then, she will progress towards a low-residue diet with 4-6 meals/day
Over an 8 week period, oral intake should begin to resemble that of a regular diet
Answer to Question 2
As stated above, post-pyloric placement of the tube is warranted in patients who are recovering from bariatric surgery forming a pouch in the stomach for improved fluid and nutrient delivery. Additionally, formula supplemented with glutamine should be considered. Glutamine, normally a nonessential amino acid, is the preferred fuel for enterocytes and is recommended for all ICU patients. During a critical illness, the body cannot produce enough glutamine and it becomes an essential amino acid. A partially hydrolyzed formula may also be necessary as the jejunum absorbs broken-down nutrients better than whole nutrients. Because he will be fed into the jejunum, we cannot bolus feed him and we will have to monitor for dumping syndrome symptoms.
See answer to question 4 regarding probably difficulty in placement of the tube.
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