FDLeyda posted Dec 22 '17 at 3:56 pm
I am a 69-year-old male. I have Muscular Dystrophy. I have not stood up for twelve years. I am in a power wheelchair. I am on a LVT 950 respiratory ventilator.
I recently had a PEG tube installed because I cannot swallow safely.

Today I started self-administering Nutren Pulmonary 1.5. It says it is a complete nutrition.

Do I need to add fiber and water to my diet or is the Nutren en
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andrea31 posted Jul 28 '17 at 4:27 pm
Hi all! I work with a NP who insists on flushing enteral tubes with gatorade for any patient with a low sodium. There is literally a bag filled with fruit punch gatorade hanging on the pole to be used as a flush. She refuses to use saline because she says it causes diarrhea. I know this is not best practice or evidence based but she insists it is. There are no ASPEN guidelines regarding this and
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mjoin037 posted May 27 '17 at 3:16 pm
Hi all, I'm having a hard time finding a consistent definition of hemodynamic stability. I've seen several different criteria used: MAP >65 for >24 hours, normal BP with stable pressors, no pressors, etc. I end up delaying feeding for longer than I'd like because many of my patients don't reach "stability" until they've been in the ICU for several days. Specific parameters are appreciated!
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recent by BRD  ·  Jul 6 '17 at 8:06 pm
I work in a long term care facility for the developmentally disabled. We recently got a new pediatric admission who is on powdered enteral formula. I am curious in other facilities, who prepares the formula for the patient? Nursing wants it to be done by the kitchen staff, but we don't feel that it should be their responsibility (concerned with sterilization and mixing the proper concentration).
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I have a patient in the ICU that has ventilator dependent hypoxemic respiratory failure mostly secondary to decompensated systolic heart failure. He is 54 years old with a BMI of 29, and his weight has been decreasing, going from 245# on March 4 to 225# on March 9. The patient has bilateral foot pitting 1+ edema and a bilateral knee nonhealing wound. His labs are: CO2 38, GLU 251, BLOOD PH 7.5
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recent by DNS1920  ·  May 17 '17 at 3:42 pm
CPN, Osmolarity, and Amino Acid Recommended "Upper Limits"
I am well aware of the limits posed by PPN on regarding osmolarity, amino acid, and dextrose concentration. However, I was just curious - does anyone have any evidence-based data on the "upper limit" or threshold for TPN/central PN for the following if such data exists):

Osmolarity
Amino acids
Dextrose
Thanks for your help in advance!
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shainafimbel posted Jul 20 '16 at 7:58 pm
I have a patient that I am contemplating putting on two different formulas, 3 cans of Jevity 1.5 and 2.5 cans of Suplena daily. Has anyone ever used two different formulas with one patient? Thanks!

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JulieRDN posted Jul 15 '16 at 6:19 pm
I work in long-term care and have a patient who has been on enteral feeding for years. I've been at this particular facility for maybe 6 months and around the time I started here we struggled with him losing weight; eventually rectified with an elemental formula. He was stable for ~3 months, then 30 days ago he started to gain and gain each week, about 12 lb total. Then just as suddenly and witho
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recent by shainafimbel  ·  Jul 20 '16 at 7:56 pm
Tulip posted Jun 30 '16 at 8:49 am
Patient has an NJ tube, 10 Fr. Kangaroo Joey feeding sets. The set is properly connected into NJ tube, but does not stay in place. The feeding sets easily disconnect from the NJ tube. Patient keeps "feeding the bed" and daytime mobility is limited due to disconnection. Feedback I get from clinicians is "that shouldn't happen" or "that is not common." It is happening and I need advice how so
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Christineb posted May 13 '16 at 12:10 am
In California, are RD's allowed to write verbal or telephone orders approved by the MD? I've hear that this is fine for diet changes and supplements, but is it ok for tube feeding or TPN orders?

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RD654 posted Feb 13 '16 at 8:22 pm
What are some reasons for a low Na levels. Flushes not exceeding EN's, no n/v/d, etc. Na: 132. BUN: 22. Thanks in advance

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Are there any RDs out there whose facility has adopted the Enhanced Recovery After Surgery protocol?

I am trying to find some pre-op CHO drinks available in the U.S. that would meet the protocol (CHO drink containing mostly maltodextrin, no protein or fat). So far no luck with Nestle or Abbott (Ensure clear etc. won't work as it is the wrong type of CHO and has protein/fat).

Thanks

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nook4412 posted Jan 14 '16 at 2:00 am
I am needing some clarity on figuring the rate for PPN's. Say a hospital has a standard formula - 4.25% dextrose, 5% AA and lipids 200 kcals/Liter.
It is a 3 in one mixture. I see these numbers but I need it broken down to figure the rate. Please someone help this math dunce out! Thanks!!

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Has anyone heard of developing high trigs from long term EN?They are not scary high but they are creeping up (177) and lipase has been elevated for a while and getting higher and well. She has been on EN for 10 months with no other issues. BG looks great. On Perative 1.3 receiving 1170kcal/day.

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irinaov posted Jan 10 '16 at 12:07 am
Hi,

I have a patient with poor PO intake and adult failure to thrive due to psychogenic dysphagia. MD is thinking about PEG placement. The problem is the patient has allergy to milk. What tube feeding formula(if any) would work for him?

I appreciate your help.



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taramz posted Jan 8 '16 at 1:23 am
Is nutren pulmonary or pulmocare an inappropriate formula to send a pt home on with Chf, copd, and pneumonia? pt was on 1200 ml fluid restriction on po prior to peg.

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lindsayh posted Dec 16 '15 at 5:23 pm
If a patient is NPO and only receiving home TPN, what is considered to be "normal" for frequency of bowel movements? Links to resources are appreciated. Thanks.

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