Enteral Nutrition Challenges in Home Case

Dietitians are now providing more in‐home visits for patients receiving enteral nutrition. Some of the current and typical challenges are summarized in this case presentation of a 45‐year‐old man being cared for at home by his mother. This patient had brain injury after a stroke and had been at home on tube feeding for ≥10 years. The home care dietitian was able to acquire pharmacologic information and the tube feeding regimen from the family. However, laboratory values, recent weight, and documentation of the patient's progress were unavailable. Home care visits by the nursing agency were infrequent, and the patient saw the primary care physician only if there was a problem. The majority of information obtained by the dietitian was through physical assessment of nutritional status, talking with family members, and observation of care. This case dealt with multiple issues including chronic constipation, poor pharmacologic management, oral feeding by the family with risk of aspiration, fluid management, underfeeding and poor sanitation as a result of limited financial resources, and inability to assess accurately the patient's tolerance and response to changes in tube feeding. The dietitian was able to provide the home care agency and the family with some practical changes in the patient's regimen to improve his overall physical status. As is often the case, the home care agency allowed only one visit by the dietitian, so follow‐up care was not available.