Please show all the calculation work on how to get the answers:

__Case Scenario: Mr. Carter__

**Case History:**

Mr. Carter is a 65 year-old African-American male, with a past medical history pertinent for HTN, tobacco use (1-1 ½ packs x 35 years), hyperlipidemia, COPD and lung cancer (in remission X 1 y), who was admitted with respiratory distress secondary to bacterial pneumonia. He presented to the ED due to worsening shortness of breath, especially during daily activities. He reports extreme difficulty getting out of bed due to muscle weakness in the lower extremities. He also has significant dyspnea on exertion, and is essentially bed-bound (non-ambulatory). Calorie counts reveal poor PO intake during this admission due to a reportedly decreased appetite.

*Update:*

Mr. Carter’s intake continued to be poor and at around Day 5 of his admission, an NG tube was placed so he could be supported with a tube feeding for the duration of his stay. His most recent weight is 54.5 kg. Calculate a *continuous (i.e. 24 hour)* ENS regimen for Mr. Carter based on the following RD-assessed needs, using each of the 5 designated formulas from the Fairview formulary listed below.

__ASSESSED NEEDS:__

Energy needs = 1800 kcals/day

Protein needs – 80 g/day

Fluid needs = 1800 ml/day using the simplest 1 ml/kcal method

**Refer to your** Adult Enteral Formulary MH Hospital**, and complete the set of questions following each one of these 5 formulas:**

**Fibersource HN****Isosource 1.5 Cal****Nutren 2.0****Replete with Fiber****Peptamen 1.5**

__A. Fibersource HN__

- Total volume of formula needed to meet the assessed energy needs
- Hourly rate at which you will need to run the feeding to deliver that daily total volume (round to the nearest 1 ml to determine the hourly rate).
- How many kcals and g protein will be provided per day at the goal volume/rate?
- Is this formula appropriate for this patient?
- How many ml free fluid are provided per day from the total volume of formula you will deliver?
- Calculate how much additional water flush you will need to give, and the volume water flush you will give every 4 hours to keep the tube patent and meet the patient’s fluid needs

__B. Isosource 1.5 Cal:__

- Total volume of formula needed to meet the assessed energy needs
- Hourly rate at which you will need to run the feeding to deliver that daily total volume (round to the nearest 1 ml to determine the hourly rate).
- How many kcals and g protein will be provided per day at the goal volume/rate?
- Is this formula appropriate for this patient?
- How many ml free fluid are provided per day from the total volume of formula you will deliver?
- Calculate how much additional water flush you will need to give, and the volume water flush you will give every 4 hours to keep the tube patent and meet the patient’s fluid needs

__C. Nutren 2.0:__

- Total volume of formula needed to meet the assessed energy needs
- Hourly rate at which you will need to run the feeding to deliver that daily total volume (round to the nearest 1 ml to determine the hourly rate).
- How many kcals and g protein will be provided per day at the goal volume/rate?
- Is this formula appropriate for this patient?
- How many ml free fluid are provided per day from the total volume of formula you will deliver?
- Calculate how much additional water flush you will need to give, and the volume water flush you will give every 4 hours to keep the tube patent and meet the patient’s fluid needs

__D. Replete with Fiber:__

- Total volume of formula needed to meet the assessed energy needs
- How many kcals and g protein will be provided per day at the goal volume/rate?
- Is this formula appropriate for this patient?
- How many ml free fluid are provided per day from the total volume of formula you will deliver?
- Calculate how much additional water flush you will need to give, and the volume water flush you will give every 4 hours to keep the tube patent and meet the patient’s fluid needs
__E. Peptamen 1.5:__

- Total volume of formula needed to meet the assessed energy needs
- How many kcals and g protein will be provided per day at the goal volume/rate?
- Is this formula appropriate for this patient?
- How many ml free fluid are provided per day from the total volume of formula you will deliver?