Question

Mrs. Wilson is a 69-year-old female who suffered a CVA 2 days ago. She now has left-sided weakness and difficulty speaking. You have the following order:

Diet: Soft, with thin liquids.

Do you have any concerns regarding Mrs. Wilson’s nutritional status and ability to eat?

If Mrs. Wilson was going to need a long-term feeding tube to receive enteral nutrition, which type of feeding tube should she receive? Why?

When giving medications through a feeding tube, are there any specific considerations?

Answer 1

1) Concern regarding Mrs.wilson nutritional status:

• High blood cholestrol is one the important risk factor for CVA, So Mrs. wilson need to lower the amount of cholestrol and fat intake in her food.
  Increased cholestrol level in the blood leeds to increased BP and it will further worsen Mrs.wilson condition.
• Limit the amount of salt intake in her food, because excess of salt or sodium intake will cause fluid retains and it will increase the BP which leads to worsen her condition more.
• After getting stroke there will be a chance of following problem may arise to Mrs.wilson such as,
  -difficult to swallow
  -inability to lift her hand and eat foods by using fork ( if she is left handed)
  -forgetting to eat and decreased appetite.
  All these thing will cause her to poor in Nutrition,
• So, Improve Nutrtion by providing easily chewable fleshy fruits and vegetables, high in fiber foods like peas, beans, oats etc..
• Advice her to keep a diet note and make her to maintain regularly inorder to ffix memory problem
  Eating ability;
• In this case, Mrs. wilson has left side weakness, if she is left handed and it is unable to mobilize her hand to bring the fork into her mouth, assist her to have a physiotheraphic exercise, if it is untreated then go for feeding by their attenders. Atlast go for tube feeding if she is unable to swallow.

2). Enteral tube feeding - Type :

If there is a need for long term tube feeding Percutaneous Endoscopic gastrectomy (PEG) type is more preferable than Nasogastric tube feeding (NGT). If Mrs. wilson require long term feeding then provide PEG tube.

• PEG tube is one of the most secure method for this client, because continuous use of NGT leads to aspiration, infection, vocal card problems, ulcertion etc..But these problems are very less in PEG tubing.
  
  But one thing should needs to be considered, that is PEG requires an Invasive procedure.

3). Specific Consideration while administering medication via Tubes :

• Flush the tube thoroughly with water before and after administering medication inorder to prevent the blockage and the drugs get sticks with that tube.
• Carefully select the appropriate tub size and load the medication with suitable amount of drugs.
• Check the nature of the medication before going to chrush the tablets or open the capsules because some mediaction get reduced in their action when it get manipulated.
• Check the time interval properly to reduce Drug nutrient interaction.

Thank you..,