HPI: 57 y/o F with PMHx of HTN, glaucoma, stroke with residual dysphagia (June 2022) now with PEG tube, and recent heart transplant (November 2022). Patient is now admitted after a fall at home due to dizziness and AMS. Found to have UTI, AKI, and dehydration. The dietitian was consulted for nutrition assessment and tube feeding recommendations. Nutrition history was obtained from the daughter, who reports the patient's PO intakes have decreased significantly over the past couple months, eating just a few bites of soft foods each day. Previously, she was eating ~1 meal/day. The rest of her nutrition is provided via her PEG tube. The daughter believes that her mom has lost some weight over the past few months. She denies nausea, vomiting, or changes in bowel habits.

Current Home TF Regimen: Osmolite 1.2 @ 3 cans per day via gravity drip. Give 1 can TID at breakfast, lunch, and dinner. Infuse each feeding over ~60 minutes or as tolerated. Flush tube with 30 ml water before and after each feeding 3x/day.

Anthropometrics:

Ht: 5'2"

Current wt: 99 lb

UBW: 110-115 lb

Weight History:

11/16/20 106 lb 2 oz

5/3/20 109 lb 7.8 oz

1/29/20 111 lb

Labs:

	Ref. Range	2/2/2021 04:00
SODIUM	Latest Ref Range: 136 - 144 mmol/L	147 H
POTASSIUM	Latest Ref Range: 3.3 - 5.1 mmol/L	3.5
CHLORIDE	Latest Ref Range: 98 - 108 mmol/L	107
CO2	Latest Ref Range: 20 - 32 mmol/L	21
BUN	Latest Ref Range: 7 - 22 MG/DL	26 H
CREATININE	Latest Ref Range: 0.6 - 1.4 MG/DL	1.5 H
GLUCOSE	Latest Ref Range: 70 - 100 MG/DL	94
CALCIUM	Latest Ref Range: 8.5 - 10.5 MG/DL	8.5
ESTIMATED GFR	Latest Ref Range: >89 ML/MIN/1.73M2	62
PHOSPHORUS	Latest Ref Range: 2.5 - 4.7 MG/DL	2.9
MAGNESIUM	Latest Ref Range: 1.8 - 2.5 MG/DL	2.1

Medications:

• Amlodipine tablet 10 mg, daily PO
• Amoxicillin-clavulanate 875-125 mg tablet, 1 tab BID PO
• Lansoprazole oral disintegrating tab 30 mg, 1 tab daily PO
• Tacrolimus 4 mg, 1 tablet BID

Answer the following questions:

1. How much nutrition is the patient receiving from her home tube feedings and flushes?

Calories: ________

Protein: ____________

Carbohydrates: ______

Water: _____________

1. What are her estimated calorie, protein, and fluid needs? Does her current home tube feeding appear adequate? Explain.

30-35

1.2-1.5

20-25 (1ML/KCAL)

1. Osmolite 1.2 is not available on formulary in the hospital. The only options are: Promote, Osmolite 1 cal, Osmolite 1.5, and Nepro. Which formula will you use? How many cans per day will you recommend? Show your calculations.

1. How will you adjust her water flushes before and after the feedings to meet her estimated water needs?