Tube Feeding Worksheet #1

1. Per the Standard Enteral Formulary Nutrition Information handout, which formula has the
highest Osmolality?
Isosource 1.5 Cal HN
2. Per the Standard Enteral Formulary Nutrition Information handout, which formula would you
recommend for a patient with COPD?
Pulmocare
3. Per the Standard Enteral Formulary Nutrition Information handout, which formulas are gluten
and lactose free?
All formulas are gluten-free
4. You have a patient that has a tube feeding order for Jevity 1.0 t/r/a 85 mls/hr.
a. What is your total volume 85*24= 2040 ml/24 hr
b. How many kcals will this provide 2040*1.06/1= 2162 Kcal
c. How many grams of protein will this provide 2162*16.7/100 = 361.05Kcal
d. How much free water will this provide 2040*835/1000 = 1703.4 ml of free water
e. The % of calories from protein is 16.7%
f. What is the Calorie to Nitrogen ratio 150:1

5. You have a patient that has a tube feeding order for Perative t/r/a 60 mls/hr.
a. What is your total volume 60*24= 1440 kcal/24 hr
b. How many kcals will this provide 1440*1.3= 1872 kcal
c. How many grams of protein will this provide 20.5% protein is given by perative
1872*20.5/100= 383.76 kcal protein/4 = 96 g protein
d. How much free water will this provide 1440*790/1000 = 1137.6 ml free water
e. The % of calories that is provided by the protein is 20.5%
f. What is the Calorie to Nitrogen ratio 122:1

6. You have a female patient that weighs 67.6 kg. You calculate her energy and protein needs using
30 kcals/kg and 1.5 g/protein/kg.
a. How many kcals does she need _67.6kg x30 =2028kcal
b. How many grams of protein does she need 67.6kg x 1.5=101.4g

7. Using the information you calculated in question #6, you decide to leave the doctor a
recommendation for tube feeding. You select the formula Perative and want the tube feeding to
run 24 hours per day.
a. What rate will you recommend = Total Rate=2028 Kcal/1.3= 1560 Kcal / 24hr
Goal Rate= Total Volume / 24hr, Goal Rate=1560/24= 65 Kcal
b. How much free water will this provide= 1000ml--->790ml-2028--->?-
790x2028=1602120/1000=1602 ml of free water
c. What recommendation will you leave for additional flushes= 2028-1602=426 ml
24/4= 6 times
426/6=71 ml / 24hour
 Tube Feeding Exercise

MNT I

Worksheet #2

1. 1000 ml Jevity 1 Cal :

Total Kcal = 1000*1.06/1= 1060 Kcal

Protein (g) = 1060*16.7/100=177.02 kcal protein

177.02/4 = 44.2 g protein

Free Water = 1060 *790/1000 = 8374 ml free water

Kcal:N = 150:1

2. 1250 ml Jevity 1.2 Cal:

Total Kcal = 1250*1.2/1 = 1500 Kcal

Protein (g) = 1500*18.5/100= 277.5 Kcal protein

277.5/4 = 69.3 g protein

Free Water =1500*805/1000= 1207.5 ml free water

Kcal:N = 135:1

3. 1250 ml Isosource 1.5 Cal :

Total Kcal = 1250x1.5=1875 Kcal

Protein (g)=1875x18/100=337 Kcal protein

337/4=84 g protein

Free Water = 1000--->778ml --->1875--->?

1875x778/1000=1459ml free water

Kcal:N= 138:1

4. Pt needs 1500 kcal and 68 g protein. Find a product that meets the patient’s needs.
Product: Isosource 1.5 Cal
 1500x6.25\68= 137.8 , Isosource 1.5 Cal

Goal Rate: Total volume \ 24 hr = X = 1500\1.5 = 1000 ml

1000 \ 24 = 41.6 = 42 ml \ 24 hr

Total kcals provided? 1000 x 1.5 = 1500 kcal

Total grams of protein provided? 1500 kcal x 18% = 270 kcal \ 4= 67.5 g

Additional water needed to meet fluid needs?

1500 - 778 = 722 ml of additional water

722 ml \ 6 = 120.3 ml ~ 120 ml \ 4 h of additional water flushes

Vitamin/mineral supplemented needed?

As formulas meet the energy and protein, so there is no need for vitamin/mineral
supplements.

5. Pt needs 2500 kcal and 115 grams of protein. Pt is receiving Isosource at 50 ml/hr/24 hours.
Does this formula/rate meet the patient’s needs?
Yes or No?

Total volume= 50x24=1200ml\24hr

1200x1.5=1800 Kcal. It doesn't meet the needs of the patient

If not, how would you modify the TF?

Change rate? No

Change formula? Yes, in order to meet the needs of the patient

Change rate and formula? No

Write a new TF order that best meets this patient's needs. Include:

Formula: Jevity 1.2 Cal

gram of protein \ 6.25 = gram of N

115g \6.25 = 18.4 g of N

total calories\ gram of N = kcal : N ratio

2500 kcal \ 18.4 g = 135.8 = 135:1

Goal rate: 2500 x 1\1.2 = 2083 ml\day

 2083 ml\24 hours = 87 ml\hr

Additional water needed: Calories - free water = ml extra water

2500 - 1677 =823 ml of additional water

How water to be provided (ml q 4 hours): 823 ml \ 6 times = 137 ml \ 4 hours

Vitamin/mineral supplemented if needed: As formulas meet the energy and protein

requirement, so there is no need for vitamin or mineral supplements.
 TUBE FEEDING EXERCISE
MNT I

Worksheet #3

Scenario: 82 yowf, 5’6”/ 168cm, 132#/60 kg, UBW 135#/61.2 kg admitted to hospital 3 days ago, albumin 2.9,
glucose 100, Dx: CVA, NPO for past 3 days due to swallowing difficulties. Speech therapy assessed patients at
high risk for aspiration.

1. Kcal Needs: Calculate REE for the above patient using the Mifflin-St. Jeor Equation.

9.99(wt) + 6.25(ht) – 4.92(age) - 161

REE = 9.99(60) + 6.25( 168 ) – 4.92 ( 82 ) - 161 = 1084.96 Kcal

Multiply by an activity factor (AF = 1.3) and an injury factor (IF = 1.1).

1084.96 * (1.3) * (1.1)=1551.4 Kcal

Total Kcal needs in 24 hours: 1551.4 Kcal

2. Protein Needs: Estimate protein needs.

Estimate Protein Needs = (1.2 gm/kg)

Grams of Protein per day:60(Wt) *1.2= 72g

Calculate your proposed calorie:N ratio

72/6.25=11.52g of N , 1551/11.52= 134:1

3. Tube Feeding: The doctor orders an RD consult for TF recommendations. What will you recommend?
Consider the following information:

Tube placement (Access): Nasoduodenal (due to swallowing difficulties)

Delivery type (continuous, bolus, intermittent): Continuous

Product/Formula: Jevity 1.2 Cal

What qualities must the TF formula have in order to meet the pts needs?
 meets protein and calorie needs.

Why did you choose the formula you chose?

because it provides adequate calories and protein.

Water flush amount: Total Volume = 1292 ml

1000 ------>805ml
1292-------> X
Free Water= 1292*805/1000= 1040 ml of free water
1551- 1040 = 511 ml
511 /6= 85 ml/4 hr
85 ml q 4 hours
Multivitamin/mineral supplementation

Since it meets energy and protein needs, there is no need for supplements.
Liquid or pill form?

Liquid form

Initiation rate of TF: 20-30ml/h

Goal rate of TF: Total volume / 24 hr

1ml------>1.2Kcal
X ml-----> 1551Kcal
1551*1/1.2= 1929
Total Volume= 1292 ml
Goal Rate=1292/24= 53.8 ~ 54 Kcal / hr