Reference no: EM133531589

Question: You receive a new MD consult for EN recommendations for a patient that was recently deemed unsafe for PO feeding. He has a history of B/L lung cancer with imaging upon admission consistent with bronchial and esophageal obstruction 2/2 a progressive mass. SLP has dx the patient with dysphagia and is recommending a long-term alternate source of nutrition. He was transferred from a tertiary hospital where he spent 2 days, and now you have been consulted on his LOS2 at your facility. Per the H&P there is also concern for SIADH 2/2 malignancy. His anthropometrics upon admission are listed as 175 cm and 47 kg (weight from prior encounter).

Your follow-up assessment was scheduled 2 days after your initial assessment. In reviewing the documentation, you see that the CorTrak tube team placed x3 tubes on the patient without success. Although they were able to place the tube, it continued to coil in the gastric fundus. You spoke with the nursing staff who report the tube clogged multiple times and they have not fed the patient more than 100 mL of formula in 2 days. They obtained a new measured weight this AM and the patient is down to 42 kg. The patient SDM is visibly upset during your visit and accuses you of "starving" the patient. At this point, you recommend PICC line placement and initiation of TPN.

RD

As the RD, you should cover the importance of providing nutrition, why the patient is high risk and requires nutrition support, as well as the actual process of placing a nasoduodenal feeding tube (i.e. what to expect).
Develop 6 questions that you think the typical patient might ask.
Reflection

Is the language used appropriately for all education levels?
Did you explain the tube or PICC placement process correctly? Was it too technical? Did it sound clear?
Were all of the patient/SDM questions fully answered?
What does your body language say?
Did you allow appropriate pauses or time for the patient to process?