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Roberto was born at 30 weeks gestation and is now 25 months old. Roberto weighs 25 pounds and is 33.5 inches long. His parents’ and extended family’s main concern is that “he is difficult to feed. He cries and refuses to eat when offered meals, even those with his favorite foods.” The registered dietitian nutritionist (RDN) who consults at the early intervention program meets with the family, assesses Roberto, and reviews his medical records. The first step by the RDN is to observe Roberto’s feeding by his mother and to evaluate his growth pattern and nutritional intake. The nutritionist and occupational therapist realize that Roberto is choking very easily, and recommend that he undergo a swallowing study. Roberto does not attend the early intervention program for the next 3 weeks. The swallowing study indicates he is aspirating some of his liquids into his lungs and so oral feeding is not safe for the moment. He requires a gastrostomy for tube feedings. His parents learn how to feed him a specialized formula through the gastrostomy tube. Nutrition services provided in the early intervention program are now documenting his growth as adjustments are made in his gastrostomy feeding schedule. Roberto gains weight over the next 6 months and becomes more interactive with the staff at the early intervention center. He begins to progress in his walking and speaking skills. The occupational and speech therapist work with his oral motor skills. A repeat swallowing study will be conducted in the near future. The goal is for Roberto to consume all of his nutrition by mouth once his swallowing is normalized and he is no longer at risk of aspirating his feedings.

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1) What are the indications that Roberto needed to have a swallowing study? (5 points)

2) Could the gastrostomy placement have been prevented if Roberto had gained weight? (5 points)

3) Using the information on page 270 (“Energy and Nutrient Needs”) and Table 10.5 (p. 271), calculate Roberto’s energy and protein requirements. (5 points)

4) The tube feeding formulary at your facility provides PediaSure® for tube feeding children. Using the information at https://pediasure.com/ (Links to an external site.) calculate the number of 8-ounce bottles of Pediasure® Grow & Gain that would be needed to meet Roberto’s requirements for energy and protein in one day. (5 points)

5) Using the Holiday-Segar method for determining pediatric fluid needs (<10 kg = 100 cc/kg; 11-20 Kg = 1000 cc + 50 cc/kg over 10 kg; 21-40 kg = 1500 cc + 20 cc/kg over 20 kg), calculate Roberto’s daily fluid requirements (5 Points) Get Nursing Help Today

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