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Chapter 8


Box 8.6 Enteral and Parenteral Nutrition Interventions for Eating Disorders (continued)


Scenario 5


The patient is eating but cannot meet the increased energy needs of hypermetabolism.


Intervention: • Initiate nocturnal NG feed per facility protocol; increase as tolerated.


• Allow the patient to eat as possible throughout day. Subtract calories eaten from total needs and provide necessary addi- tional calories continuously through the night until 3 to 4 hours before breakfast.


• Discontinue tube-feeding when metabolic rate normalizes and the patient is able to meet 90% to 100% of nutritional needs by mouth.


Scenario 6


The patient is medically unstable and, although willing to eat, cannot meet nutritional needs with food.


Intervention: • Initiate continuous NG feed per facility protocol; provide total calories via 24-hour continuous drip.


• Allow the patient to eat as possible during the day, while increasing tube feeding to meet total energy needs. Once 100% of nutrient needs are being met via tube-feeding and oral intake, reduce tube feeding volume as oral intake increases.


• Discontinue tube-feeding (remove tube) once the patient is medically stable and/or able to meet 90% to 100% of nutri- ent needs by mouth.


Scenario 7


The patient has gastrointestinal (GI) dysfunction, such as involuntary regurgitation of food (gut rest not required).


Intervention: • Initiate NG or naso-jejunal (NJ) feed, depending on the loca- tion of GI dysfunction; advance as tolerated to provide total calories via 24-hour continuous drip.


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