Plan a tube-feeding schedule for a stroke patient on bolus feeds, describe how to give a feed safely, and calculate his water intake.

1. 1 · Aim. To plan the feeding schedule, safe method and water for Mr. S.
2. 2 · Principles.
   • Fixed times; bolus or continuous
   • Build up slowly; watch for refeeding syndrome
   • Head raised 30-45°; check tube position
   • Flush 30 mL before and after; strict hygiene; monitor
3. 3 · Feeding prescription. 1800 mL a day as six 300 mL feeds every 3 hours; 30 mL flushes; two extra water feeds.
4. 4 · Schedule. [Table: Time | Feed or water | Volume, 6 am to 9 pm]
5. 5 · Water calculation. Need 60 × 35 = 2100 mL; feed water 1800 × 0.84 = 1512 mL; flushes 360 mL; extra water about 230 mL; pump rate if continuous 1800 ÷ 20 = 90 mL/h.
6. 6 · Method of giving a bolus feed.
   • Wash hands, raise head, check position
   • Flush 30 mL, feed over 20-30 minutes, flush 30 mL
   • Keep upright 30 minutes, record
7. 7 · Complications and monitoring. Diarrhoea, aspiration, blockage, refeeding syndrome; monitor volume, stools, distension, urine, weight.
8. 8 · Result. Mr. S receives about 1779 kcal, 69 g protein and 2.1 L water a day on a fixed 3-hourly schedule.

Scoring tip: Show the water arithmetic (feed water + flushes + extra water = 2100 mL); it is the calculation examiners expect in this question.