SB is a 60-year-old retired sales associate.SB c/o abdominal pain, often severe, nausea, and vomiting.She then began to experience back pain and reports seeing a little oil in her stool.SB says that she is unable to eat anything because she just vomits it back up.Because of SB's persistent symptoms, she checked into the hospital and an ultrasound and CT scan was administered.SB was diagnosed with severe acute pancreatitis.SB was NPO until symptoms ceased and was given Demerol.By day 5, SB's N/V had not yet been alleviated.SB was scheduled for a nasogastric suctioning. Ht: 5'5" Wt: 145# UBW: 175# Dx: severe acute pancreatitis PMH: cholelithiasis s/p shock-wave lithotripsy Labs:

Ser Ca: 5 mg/dL Amy: 122 U/L Alb: 3.0 g/dL Hct: 34%

Mg: 1.4 mEq/L Lip: 65 U/L Transferrin: 210 mg/dL Hb: 12.3

TG: 387 mg/dL

Meds: Demerol Diet: NPO -SB is not tolerating gastric feeds What will the registered dietitian now attempt?

Question

SB is a 60-year-old retired sales associate.SB c/o abdominal pain, often severe, nausea, and vomiting.She then began to experience back pain and reports seeing a little oil in her stool.SB says that she is unable to eat anything because she just vomits it back up.Because of SB's persistent symptoms, she checked into the hospital and an ultrasound and CT scan was administered.SB was diagnosed with severe acute pancreatitis.SB was NPO until symptoms ceased and was given Demerol.By day 5, SB's N/V had not yet been alleviated.SB was scheduled for a nasogastric suctioning.
Ht: 5'5" Wt: 145# UBW: 175#
Dx: severe acute pancreatitis
PMH: cholelithiasis s/p shock-wave lithotripsy
Labs:

Ser Ca: 5 mg/dL	Amy: 122 U/L	Alb: 3.0 g/dL	Hct: 34%
Mg: 1.4 mEq/L	Lip: 65 U/L	Transferrin: 210 mg/dL	Hb: 12.3
TG: 387 mg/dL

Meds: Demerol Diet: NPO -SB is not tolerating gastric feeds What will the registered dietitian now attempt?

Quizplus · Accepted Answer

Since SB is not tolerating gastric feeds, the best option is to attempt nasojejunal EN (enteral nutrition given through a tube that bypasses the stomach and goes directly into the small intestine). This will provide nutrition while allowing the pancreas to rest and heal. PN (parenteral nutrition) may be considered if EN is not feasible or if there are complications, but it is a more invasive and expensive option. NPO (nothing by mouth) is not a viable long-term solution for meeting SB's nutritional needs. Nasogastric feedings with a motility agent may not be effective if there is underlying gastrointestinal dysfunction, which could further exacerbate symptoms. Since SB is not tolerating gastric feeds, the best option would be to attempt nasojejunal enteral nutrition to provide necessary nutrients while allowing the pancreas to rest. PN would be a last resort option as it has potential for complications and should only be used if enteral nutrition is not feasible. NPO would not provide the necessary nutrition and may prolong recovery time. Nasogastric feedings with a motility agent may not be effective in resolving SB's symptoms and could potentially worsen them.

SB Is a 60-Year-Old Retired Sales Associate