NEW BOOK: cnu.sellfy.store/ ALSO ON AMAZON: a.co/d/6C6lXGa ________________________________ This video was recorded at a speed to accommodate all learners. If you're a fast learner, listen at 1.25x or 1.5x by adjusting the playback speed under Settings.
This video is ABSOLUTELY incredible! This is the best step-by-step explanation of how to calculate continuous TF, I've ever watched. I will be sharing this with interns in my cohort.
I don’t believe that finally I found a channel by which I can understand all the lacks that I meet while I was studying !!! Thank you so much for this video! Please keep going !
Thanks for watching! There are some similarities, but you will definitely want to check out my video on bolus feeding to make sure you catch all the differences/nuances - th-cam.com/video/qCoGWhBaasE/w-d-xo.htmlsi=3HBJ60g520AhewWb
Absolutely helpful . But how will you know the amount of protein that's present in different density fornulas . Like you said there's 55 g / ltrPlease replyyyyy it'll be very helpful to me
The 55 g/L was just a number I made up for the example. In practice, the manufacturer of the formula (i.e. Nestle or Abbott) will provide all of the information for the nutritional composition. All you need is the name of the formula and you should be able to track down the grams of protein, % of H2O, concentration of vitamins/minerals, etc.
Would you start at a lower rate in this case, like start at 50% (40 ml/hr) as tolerated until meeting goal rate of 80 ml/hr? Or do you only do that if the pt has a high risk of intolerance?
For a patient like this - who is being started on enteral feeds for the first time - yes. I would have the nurse start at 30 mL/hr and then increase 10-15 mL/hr every ~4 hours to goal. But for a patient who has a recent history of tolerating feeds at goal - like a tube fed-dependent patient who presents for an unrelated issue - then I would recommend starting at the goal rate.
Since the formula is 81% H2O, the regimen of 1920 mL formula per day (80 x 24) gives 1,555 mL of H2O. Add 750 mL to that for free H2O flushes, and you have 2,305 mL H2O per day. In therms of finding the % H2O formula, that information is always published by the manufacturer. You can find it on their website, or in most hospitals, it will be written on a formulary card that’s given to the dietitians.
just a quick question, for free water flush could you calculate this by taking the upper end of the patient's requirement and subtract it to the amount of water in the formula? (e.g., 2520 - 1,555 ml = 965 ml of free water)
What about someone meeting calorie goals continuous but on 1.5 instead of 1.2? What rate do you suggest and flush please? Dad has chronic kidney disease and on a 1.5 peptide formula called Kate farms. Instead of the usual jeveity formula brand.
Hey Sarah! You would have to get a registered dietitian to perform a full nutrition assessment on your father. I cannot determine the rate he needs just based on his medical condition and the type of formula he receives.
Intubated? Intubation does not mean you must avoid fiber! However, sometimes during critical illness - particularly when there’s a high pressor requirement - clinicians will avoid fiber to minimize risk of bowel ischemia.
Not necessarily. In some situations you may consider that, especially if you feel their body size is affecting nursing care and quality of life. But in other situations - like if a patient has cirrhosis or is on dialysis - being of a larger body size may actually be protective. Each patient must be considered on a case-by-case basis!
My mum has a peg tude the milk was making her sick so I started blending her food she is intakeing a 1000 caroies a day she is maintain her weight at 121 however I would like to give her more caroies per day I need help
So i have a case study. Pt needs to be diabetisource ac Gj tube Continuous 24hrs Needs are: 1780-1978kcal 118-130g protein I have no problem getting to the calories but whenever i use this formula the protein is always under his needs. How do i approahc that?
Without knowing the full details of the case or running any numbers myself, it sounds like the formula doesn’t provide an adequate amount of protein to meet the estimated need. In this case, you would either need to add a protein modular (i.e. Beneprotein or Pro-Stat) to increase the number of grams provided each day, or you would need to switch to a different formula that can satisfy both the estimated energy and protein need.
Thats what i assumed i would have to do but i wasnt sure cuz not recahing that goal for protein was measing me uppp! Literally u are such a blessing sir
@@jedyalucas4684 You’re welcome! Wish I could give a better answer. You’ll always want to factor fluid received from IV fluids. But the goal is to have your patients off of IV and receiving 100% of their fluid and electrolyte needs through the enteral feeds.
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NEW BOOK: cnu.sellfy.store/
ALSO ON AMAZON: a.co/d/6C6lXGa
________________________________
This video was recorded at a speed to accommodate all learners.
If you're a fast learner, listen at 1.25x or 1.5x by adjusting the playback speed under Settings.
Pls continue to talk slowly, its the way that I am able to follow your teaching. You are amazing. Thank you sooooo very much for this channel.
This channel is single handedly saving me during my clinical rotations
This makes me so happy! So glad you're finding the content helpful. Let me know if you run into any issues that you have questions about! 😊
This video is ABSOLUTELY incredible! This is the best step-by-step explanation of how to calculate continuous TF, I've ever watched. I will be sharing this with interns in my cohort.
Thank you so much! I’m so happy to hear you are finding my videos helpful 😎
I agree! I don’t calculate feedings often…this was a great step by step video! Thank you!
I don’t believe that finally I found a channel by which I can understand all the lacks that I meet while I was studying !!!
Thank you so much for this video! Please keep going !
Thanks for watching, Fatima! So happy to hear you’re enjoying the videos! 😊
This is now my lecture theatre..your content is super duper helpful! Thank you very much and God bless you...
So happy to hear you’re enjoying the channel! Thank you for watching! 🙏🏼
Thank you - this has been a great help! It's great to show the step by step process and makes it less intimidating to do.
I agree that the steps make it easier to understand! Thanks for tuning it and letting me know you found it helpful 🤗
I can't thank you enough! So neat, clear and precise! THANK YOU!❤
Hey Hiba! I’m happy to hear you enjoyed the way this was presented. Thank you for tuning in to CNU 🤗
Thanks for the explanation
Question: Can i use the same calculation formula , but writing a prescription for bolus feeding?
Thanks for watching! There are some similarities, but you will definitely want to check out my video on bolus feeding to make sure you catch all the differences/nuances - th-cam.com/video/qCoGWhBaasE/w-d-xo.htmlsi=3HBJ60g520AhewWb
Thanks a lot! It was so helpful, obvious and easy to undrasrand.
Happy to hear you found it helpful and easy to understand. That’s what I am for!
It was so helpful. Thank you so much.
Absolutely helpful . But how will you know the amount of protein that's present in different density fornulas . Like you said there's 55 g / ltrPlease replyyyyy it'll be very helpful to me
The 55 g/L was just a number I made up for the example. In practice, the manufacturer of the formula (i.e. Nestle or Abbott) will provide all of the information for the nutritional composition. All you need is the name of the formula and you should be able to track down the grams of protein, % of H2O, concentration of vitamins/minerals, etc.
Great teaching thank you so much!
Thank you very much! Great video
You’re welcome! Happy to hear you enjoyed it 😊
What about initiation rates? do you also have a video on this?
Would you start at a lower rate in this case, like start at 50% (40 ml/hr) as tolerated until meeting goal rate of 80 ml/hr? Or do you only do that if the pt has a high risk of intolerance?
For a patient like this - who is being started on enteral feeds for the first time - yes. I would have the nurse start at 30 mL/hr and then increase 10-15 mL/hr every ~4 hours to goal. But for a patient who has a recent history of tolerating feeds at goal - like a tube fed-dependent patient who presents for an unrelated issue - then I would recommend starting at the goal rate.
How did you get 2,305 ml of water per day? Also, where do you find the % of water in your formula you selected?
Since the formula is 81% H2O, the regimen of 1920 mL formula per day (80 x 24) gives 1,555 mL of H2O. Add 750 mL to that for free H2O flushes, and you have 2,305 mL H2O per day. In therms of finding the % H2O formula, that information is always published by the manufacturer. You can find it on their website, or in most hospitals, it will be written on a formulary card that’s given to the dietitians.
@@clinicalnutritionuniversity When taking 1,920mL x (.81 x .01)=15.552
How did you convert 15.552 to 1,555mL?
@@mindfulhoneyhealth2182 I see where you’re getting confused! It would be 1920 x .81, or 1920 x (81 x .01). Not 1920 x (.81 x .01)!
@@clinicalnutritionuniversity Thank you!
just a quick question, for free water flush could you calculate this by taking the upper end of the patient's requirement and subtract it to the amount of water in the formula? (e.g., 2520 - 1,555 ml = 965 ml of free water)
Do you know the answer to this question yet please? Thank you
but how did get 1920ml (19.2L)
What about someone meeting calorie goals continuous but on 1.5 instead of 1.2? What rate do you suggest and flush please? Dad has chronic kidney disease and on a 1.5 peptide formula called Kate farms. Instead of the usual jeveity formula brand.
Hey Sarah! You would have to get a registered dietitian to perform a full nutrition assessment on your father. I cannot determine the rate he needs just based on his medical condition and the type of formula he receives.
The pt in the case study is incubated. For this case, shall I choose a standard formula without fiber?
Thank you!
Intubated? Intubation does not mean you must avoid fiber! However, sometimes during critical illness - particularly when there’s a high pressor requirement - clinicians will avoid fiber to minimize risk of bowel ischemia.
Excellent
Thank you so much 😊
What in case if the fluid requirement is met then how do we estimate free water flushes?
What if the patient is obese 1 according to WHO and needs to be in a nasogastric tube? Should the patient's goal be Weight loss and achieve its IBW?
Not necessarily. In some situations you may consider that, especially if you feel their body size is affecting nursing care and quality of life. But in other situations - like if a patient has cirrhosis or is on dialysis - being of a larger body size may actually be protective. Each patient must be considered on a case-by-case basis!
@@clinicalnutritionuniversity Thank you so much! I appreciate the reply. God bless 🤍
My mum has a peg tude the milk was making her sick so I started blending her food she is intakeing a 1000 caroies a day she is maintain her weight at 121 however I would like to give her more caroies per day I need help
So i have a case study. Pt needs to be diabetisource ac Gj tube
Continuous 24hrs
Needs are: 1780-1978kcal
118-130g protein
I have no problem getting to the calories but whenever i use this formula the protein is always under his needs. How do i approahc that?
Without knowing the full details of the case or running any numbers myself, it sounds like the formula doesn’t provide an adequate amount of protein to meet the estimated need. In this case, you would either need to add a protein modular (i.e. Beneprotein or Pro-Stat) to increase the number of grams provided each day, or you would need to switch to a different formula that can satisfy both the estimated energy and protein need.
Thats what i assumed i would have to do but i wasnt sure cuz not recahing that goal for protein was measing me uppp! Literally u are such a blessing sir
Thank you very much
Thanks for watching!
Thank u.
Please make more videos
I promise you that I’m making them as fast as I can! I wish I could do it faster! 😅
How about the fluid if the patient receive Intravenous fluid?
That would totally depend on how much intravenous fluid the patient is receiving and would need to be discussed with the interdisciplinary team!
@@clinicalnutritionuniversity thankyou for your answer 🤓 didnt expect you replied that fast.
@@jedyalucas4684 You’re welcome! Wish I could give a better answer. You’ll always want to factor fluid received from IV fluids. But the goal is to have your patients off of IV and receiving 100% of their fluid and electrolyte needs through the enteral feeds.
Thanks alot
Great.
Why the hospital only giving my grown son 50 ml feeding in IV and hour this just don’t seem like enough food when he need to gain weight 😢