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...by the NSW Enteral/Parenteral Interest Group. Correspondence should be directed to Suzie Ferrie, Interest Group Secretary, Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Camperdown NSW 2050, email suzie.ferrie@email.cs.nsw.gov.au.

Introduction

Several surveys have indicated that 30% to 40% of hospital patients are malnourished. Appropriate nutrition support may reduce hospital complications, length of hospital stay, cost of hospital stay, and even mortality (1) The dietitian is an essential part of nutrition support management, ensuring that suitable nutrition support strategies are chosen, any problems or risks are identified early, the individual patient's needs are met, and inadequate or excessive feeding is avoided.

1. Which of the following are possible reasons to consider tube feeding in patients who have had stroke?

a. reduced level of consciousness

b. dysphasia

c. arm or facial weakness

d. dysphagia

e. a, c and d.

2. Which of the following is not a valid reason for avoiding the use of a nasogastric tube (NGT)?

a. the patient has a recent fracture to the base of skull, increasing the risk of a dangerous tube misplacement

b. the patient has no bowel sounds, therefore the gut may not be working, increasing the risk of aspiration

c. the patient has acute pancreatitis, and feeding into the stomach would stimulate pancreatic activity and exacerbate the pancreatitis

d. the platelet count is low (12 X [10.sup.9]/L), increasing the risk of a significant bleed upon insertion of the tube

3. A patient is identified as being at high risk for refeeding syndrome and has to start tube feeding. After a thorough medical assessment, what is the most appropriate nutritional management?

a. start enteral feeding as soon as possible, according to the hospital's standard protocol. (i.e. using a standard feeding formula and advancing the feed rate by 30-40m L/h every four hours until goal feed rate is reached)

b. start a trial of water via the nasogastric tube for 24 hours,...

NOTE: All illustrations and photos have been removed from this article.



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