Question

Case Study

John Casey is a 28-year-old carpenter who suffered severe trauma to the head in a wood-cutting accident. He has remained in a coma in the Intensive Care Unit since his accident 4 days ago. His wife has been by his side the entire time and wishes that all effort be given to his recovery. His medical history reveals he was in good health prior to his accident. He is 72 inches tall and weighs 180 pounds. He appears well-nourished and physically strong. Laboratory blood tests reveal low albumin and red blood cell count. His wife states that he has no food or drug allergies and asks what can be done to provide for his nutritional needs. The nutrition support team decides to initiate continuous (24 hours) enteral nutrition support via a nasogastric tube.

1) What routine test is necessary with enteral feedings to ensure John's stomach is emptying properly? What can be done to resolve high gastric residuals?

2)What changes in nutrition support may need to be considered if John requires enteral nutrition for several weeks or longer?

Answer 1

1. Aspirating for gastric residual volume should be done

in case of high GRV, prokinetic medicine like metoclopramide can be given. Stool softeners also increase gastric moyility. Furthur hyperglycemia is linked to slowing of gastric emptying so control of blood sugar level should be considered. Otherwise post pyloric or jejunal feed can be initiated.

2. Nutrition assessment should be made on regular basis if he is getting adequate calorie and protein. Patient should be assessed for feed tolerance. Always make sure if required amount of feed is delivered at appropriate feed rate. Care should be taken of feeding equipments. Flushing of tube is mandatory so as to avoid blockage. Patient head should be elevated while feeding.

adequacy of nutrition support should be assessed according to height and weight, any changes according to presence of infections, improvement in condition should be made.
Protein supplements should be considered.

glutamine supplementation should be utilized