CLINICAL
Kate Roberts RD Freelance Dietitan Kate is a Freelance Dietitian with a wide range of clinical experience of working with adults and children from previously working in the NHS, her specialities are Diabetes and Allergies.
CASE STUDY: ENTERAL FEEDING AND NUTRITION SUPPORT IN A PATIENT WITH DUCHENNE’S MUSCULAR DYSTROPHY This is a case study of a 17-year-old boy with Duchenne’s muscular dystrophy (DMD). His case was complicated due to ensuring his wishes, family dynamics and problems with establishing his weight. I first met Master M when he was referred to the Nutrition and Dietetic Service when he needed nasogastric (NG) feeding on the ward. There was no weight completed on admission. He had been admitted due to shortness of breath and a productive cough and was diagnosed with a lower
respiratory tract infection. His previous medical history included DMD and one previous admission for pneumonia. Master M was wheelchair bound and lives with mother and siblings. His mother is his main carer. The only medicine he had been taking was Movicol.
1 ASSESSMENT Weight history: 54kg 15 months ago, unable to weigh on the ward. Nutritional diagnosis: Inadequate energy intake related to dysphagia evidenced by deteriorating nutritional status and chest infection. Overall aims of treatment as an inpatient To meet the patient’s estimated nutritional requirements via nasogastric (NG) feeding by Day 6 of his regimen. To prevent any further weight loss by meeting his estimated nutritional requirements by Day 6 of his feeding regimen. To re-establish oral intake hopefully within one month as directed by Speech and Language following a videofluoroscopy (VFS). First assessment on Day 6 of inpatient stay Anthropometrics Weight: 47kg, height 1.572m, BMI: 19kg/m2. Approximation based on discussion with mother. However, he appeared undernourished. He was already being seen by the Physiotherapists and Speech and Language Therapists (SLT). An SLT had advised stage 1 fluids via teaspoon only and nil by mouth would be safest for food, NG tube if for active treatment. They also arranged a VFS. Master M reported that he will be drinking up to 800mls as per SLT recommendations. He was nil by mouth. The NG feed was on the out-of-hours regimen and ran at 20ml/hr the day before until 0100hrs. Master M and his mother consented to the NG tube. He was keen to only have NG feed during the day and wanted to be able to switch it off for bathroom breaks and physiotherapy. 2 IDENTIFICATION OF NUTRITION AND DIETETIC DIAGNOSIS Objectives: At initial assessment, estimate nutritional requirements based on estimated weight using Schofield. Meet estimated nutritional requirements via NG tube by Day 6 of feeding regimen. Continued overleaf . . .
www.NHDmag.com August/September 2017 - Issue 127
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