Vitamins are energy-building nutrients that contribute to sound nutritional health. Water, on the other hand, is responsible for carrying necessary nutrients and removing waste products throughout our body. A human body is made out of mostly water and is critical to our health. Similarly, minerals and electrolytes are essential to human health and can be obtained in our diet from different foods. When humans are too sick to consume a regular diet, digestion and absorption may impact the supply of necessary nutrients, requiring specialized nutritional support to meet their nutritional needs.
After studying Module 4: Lecture Materials & Resources, read the case study and answer the prompts:
Sharyn Bartell is a 24-year-old student who suffered multiple fractures when she fell from a cliff when hiking. As a result of the accident, she is immobile, in traction, and had a small bowel resection. She is able to keep her head up to 45 degrees. Sharyn used to weigh 140 pounds but has lost 8 pounds since the accident. The healthcare team agrees that Sharyn will need a feeding tube before her nutritional status deteriorates any further.
Navigate the web, research a high protein formula that can be administered via feeding tube and share 1) name of formula, 2) nutrient composition, and 3) indications for use.
Navigate to the Oley Foundation: Dietary Recommendations for Patients with Intestinal Failure - Oley FoundationLinks to an external site., read “Physiological Considerations” and discuss in at least one paragraph with two (2) effects of the small bowel resection on Sharyn’s fluid and electrolyte balance.
Navigate to the Oley Foundation: Living with Enteral Feeds - Oley FoundationLinks to an external site. and provide two (2) physical or psychosocial adjustments Sharyn will have to make when living with a feeding tube.
Full Answer Section
- Indications for Use:
- Patients with impaired GI function (like Sharyn's small bowel resection)
- Patients with increased protein needs (due to trauma, surgery, or burns, as in Sharyn's case)
- Patients who are critically ill or unable to eat (Sharyn's immobility and traction prevent oral intake)
- Patients requiring tube feeding (Sharyn will need a feeding tube).
2. Effects of Small Bowel Resection on Fluid and Electrolyte Balance:
Sharyn's small bowel resection will likely have significant effects on her fluid and electrolyte balance. The small intestine is the primary site for nutrient and fluid absorption. Two key effects include:
- Malabsorption: A significant portion of the small bowel is responsible for absorbing fluids, electrolytes, and nutrients. Resection of a part of the small bowel directly reduces the absorptive surface area. This can lead to malabsorption of essential nutrients, including electrolytes like sodium, potassium, and magnesium, as well as fluids. This malabsorption can manifest as diarrhea, further exacerbating fluid and electrolyte losses. The type and degree of malabsorption depend on the extent and location of the resection.
- Increased Risk of Dehydration: Reduced fluid absorption in the small bowel, coupled with potential diarrhea, puts Sharyn at high risk for dehydration. Dehydration can lead to electrolyte imbalances, further complicating her recovery. Monitoring for signs of dehydration (e.g., decreased urine output, dry mouth, dizziness) and closely managing her fluid intake and electrolyte levels are crucial.
3. Physical and Psychosocial Adjustments with a Feeding Tube:
Living with a feeding tube requires significant adjustments, both physically and psychosocially. Two examples include:
- Body Image and Self-Esteem: Sharyn, being a young adult, may struggle with the change in her body image due to the presence of the feeding tube. It can impact her self-esteem and sense of normalcy. Providing emotional support, counseling, and resources to help her cope with these changes is essential. It's important to acknowledge her feelings and help her adapt to her new reality.
- Social Activities and Eating: The feeding tube can affect Sharyn's ability to participate in social activities that revolve around food. She may feel self-conscious about eating in public or attending social gatherings where food is involved. This can lead to social isolation and feelings of exclusion. It's important to encourage her to maintain social connections and explore ways to participate in social events, even with the feeding tube. Support groups and connecting with other individuals who have feeding tubes can be beneficial.
Sample Answer
Let's address Sharyn's nutritional needs and the adjustments she'll face.
1. High-Protein Formula for Enteral Feeding:
A suitable high-protein formula for Sharyn, given her multiple fractures, immobility, and small bowel resection, would likely be something like Nestlé Peptamen AF.
- Nutrient Composition (Typical per 1000 mL):
- Protein: ~44g (Hydrolyzed whey protein, for easier digestion given the bowel resection)
- Carbohydrate: ~125g (Often includes maltodextrin)
- Fat: ~40g (Often includes MCT oil for easier absorption, important with small bowel resection)
- Vitamins and Minerals: Provides essential micronutrients to meet daily requirements. Specific amounts vary by product.
- Calories: ~1500 kcal