Routes are many : Goal is One – Nutrition Support
U Uthara, Chief Dietitian
Timely and goal-oriented nutrition support goes a long way in the speedy recovery of patients. Debilitating diseases such as cancer require the utmost nutritional care. Malnutrition can quickly set-in in these patients primarily due to poor intake because of the disease as well as the various treatment modalities such as surgery, chemotherapy, radiation therapy, etc.
At SIMS, we recently received a patient from Bangladesh, a 62-year-old female, diagnosed with pancreatic cancer. Due to prolonged poor oral intake, the patient was malnourished and had decreased fat stores also. The same findings were reported in the Nutritional Assessment done by the dietitian. She was initiated on oral diet along with ONS (Oral Nutrition Supplement), and her oral intake was closely monitored. The patient was taken for surgery following which oral/enteral feeding could not be initiated. Considering her history of malnutrition, the Nutrition Team and the Consultants, aptly decided to feed her intravenously, commonly called as Parenteral Nutrition. This was planned by the dietitians and nutrition support was initiated. Slowly the feeding rate was increased to match the nutritional requirements.
As the patient improved, tube feeding was initiated and parenteral Nutrition was tapered down. The Nutritionists at SIMS chose the right formula and volume, based on the patient’s tolerance and condition. The formula was reconstituted according to the dilution and instructions are given by the dietitian, in a separate Liquid Section located in the Food and Beverage department of the hospital. The patient tolerated tube feeds well and her nutritional status started showing progress. From a sober state, she started greeting us with a smile during our rounds. The dietitians, after discussing with the consultants, initiated oral liquid diet followed by a soft solid diet. A lot of encouragement and motivation was required, for the patient to try oral feeds, after prolonged under-eating prior to surgery. The dietitians spent a lot of time explaining the importance of nutrition for a speedy recovery, suggested various types of soft foods, and emphasized the need for ONS (Oral Nutrition Supplement) during the recovery phase. Teamwork is the key to success. In this case, the consultant, the nutritionist, the nurses and the patient’s family worked as a team. And there… the patient started taking oral food well, carefully followed the dietitian’s advice on high protein soft solid diet, improved clinically and nutritionally and got discharged happily. This enhanced nutritional state and consistent nutrition support will also help her withstand the future course of treatment. The family expressed profuse thanks to the team at SIMS – the consultants, nutritionists and the nurses for giving a new lease of life and hope, with better nutritional status!
In this case, all the three routes of Nutrition support were used: Parenteral (through IV), Enteral (tube feeding) and oral! The goal was one — to improve the nutritional status of a malnourished patient, and with the help of a team, the goal was finally achieved!