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What is the first step in calculating an enteral- tube feed-regimen?
- Calculate calorie needs by determining dosing weight and either stress factor(1.2 low-1.5 high) or activity needs(1.2 not active -1.6? active).
- You can combine stress +activity factrs (ex:1.2+1.2=1.4)
- convert lbs to kg (by divide by 2.2)
- convert inch to cm (by multiply by 2.54)
- use either: current weight (common), adjusted (if overweight), dry (if have extra water), or ideal
Using HB plus calculate the RRE
Multiply REE by either stress or activity factor to get TEE
What is the second step in cal. enteral process?
Protein needs (g)
Take weight (in kg) and multiply by protein needs
Never really use 0.8 g (is for healthy people), use at least 1.0!
- for elderly use at least 1.2-1.3
- use 1.1 for pregnancy?
- Use 1.4-1.5 for trauma
What is the third step in cal. enteral process?
Fluid needs (ml)
USE 30-35 cc/kg range!
Choose how much fluid and multiply by weight (kg) for ml amount
What is next after calculating fluid needs?
- choose the tube site palcement (og, ng, nd,nh, peg, pej)
- continous or bolus???? (usually continous)
- choose formula
What comes after determining the choosing the site and formula?
calculate volume of formula that is needed to meet patient energy needs (remember the calorie needs must stay within 100 calorie range!)
- Take the formula ml/kcal and multiply by the TEE
What comes after determing the volume of formula needed?
determine the amount of protein needed
- the 56 g is the formula amount.
- **Make sure the protein amount meets the patients needs!!!
What comes after determining the protein need from the formula?
calculate the free water
1230 ml x 0.81 = 1000 ml
0.81 is the given amount of free water (convert from 81% to 0.81)
What comes after determining the amount of free water?
calculate the water deficit
ex: Jevity 1.2 1200 ml water (a given), 81% free water (given), 1000 ml water (free water)
1890 ml (patient need)- 1000 ml (free water) =890 ml water deficit
What is the final step of the enteral prescription?
- ex: Initiate PEJ feeds with Peptamin 1.5 at 20 ml/hr (range from 10-50 ml), advance by 10 ml for every 8 hrs (range from 10-20 ml) to goal rate of 50 ml/hr.
- (50 ml because multiply it by 24 and it is 1200 ml/day, which provides her with her total kcal from formula)
Provides 1476 kcals, 69g protein, 1000 ml free water
Pateint will need additional 890 ml free water/ 24 hrs to meet hydration needs.