Mrs. McCormick's MD discusses the potential for the placement of a PEG tube for this patient. Provide any justification for nutrition support using the appropriate criteria and guidelines

Question

What will be an ideal response?

Answer 1

• It is reasonable to suggest long-term enteral feeding for this patient; indications that this patient needs long-term enteral feeding include an inability to consume adequate nutrition orally due to problems swallowing, decreased motor ability with history of progressive Parkinson's disease, and increased nutritional needs as evidenced by a 20# weight loss. The malnutrition is also apparent as muscle wasting (quadriceps, gastrocnemius, and temporal wasting) and fat loss (periorbital fat pads) are prominent. Also, this patient has no issues with digestion of food or problems with the GI tract besides constipation, meaning that enteral feeding is the best option for nutritional support; this patient's normal bowel sounds indicate that the GI tract is working.
- With the history of Parkinson's disease and a decrease in motor function, it is appropriate to check for an obstruction within the bowel or to administer constipation medications to correct this issue before feeding enterally.
• A PEG tube is most appropriate to feed a patient via the stomach if the need is greater than 90 days. It is important to monitor for aspiration with the increased risk of feeding through the stomach/history of swallowing issues, but this route is most physiologic, most convenient for bolus feedings around the medication regimen, and least costly.