A tube feeding is a medical device that is used to provide nutrition to a resident who may not be able to obtain proper nutrition orally or not able to swallow properly or safely. A feeding tube may be permanent or temporary for the treatment of acute or chronic conditions. Once a resident is either admitted or readmitted to the facility with a feeding tube, it is the dietitian’s responsibility to properly assess the resident’s nutritional status and determine if the current formula and flushes are appropriate.
Upon reviewing the medical chart, the dietitian will first examine why the resident is on the tube feeding. The resident may have a diagnosis of dysphagia, history of aspiration pneumonia, poor oral intake, etc. Some residents may also be on a dual feeding which would be a tube feeding along with an oral diet.
Other important areas the dietitian will review include:
- Is edema present?
- Is the resident tolerating the current feeding?
- Is there any diarrhea or constipation?
- Is nausea or vomiting present?
- Are there any skin issues?
- Pertinent lab values?
- Current medications?
Key information to obtain would be height and weight of the resident which allows the dietitian to complete the nutritional needs and BMI (body mass index) for the resident. It is critical that the accurate height and weight for the resident be obtained upon admission. The dietitian will then calculate the estimated nutritional needs. There are various ways to calculated nutritional needs and there is no one correct way so the dietitian will use the formula for calculating that they use most often.
The dietitian will calculate the number of calories, protein, free water and total water provided by the tube feeding and determine if the current tube feeding order is meeting the estimated nutritional needs of the resident. If the tube feeding needs to be adjusted to better meet the resident’s nutritional needs, then the dietitian will make a recommendation to the physician. Tube feeding residents should be followed regularly by the dietitian in order to review tolerance, weight status, skin, labs etc., and make any further recommendations as needed.