Explain the indications, routes and types of tube feeds, and work out the feed requirement for a stroke patient on a Ryle's tube.

1. 1 · Aim. To choose the route and feed and calculate the requirement for Mr. S.
2. 2 · Indications and contraindications.
   • Gut works but oral intake is unsafe or not enough: stroke, unconsciousness, head and neck cancer, ICU, burns
   • Not used in obstruction, severe GI bleeding, uncontrolled vomiting, shock
3. 3 · Routes. [Table: nasogastric | nasojejunal | PEG | jejunostomy, with when used]
4. 4 · Types of feed. Kitchen-based blenderised versus commercial (standard 1 kcal/mL, energy-dense 1.5-2 kcal/mL, peptide, disease-specific, modular).
5. 5 · Requirement. Energy 60 × 30 = 1800 kcal; protein 60 × 1.0-1.2 = 60-72 g; water 60 × 35 = 2100 mL; feed 1800 mL at 1 kcal/mL.
6. 6 · Feeding plan. Six bolus feeds of 300 mL every 3 hours, built up from about 100 mL on day 1.
7. 7 · Result. Mr. S needs about 1800 kcal, 65-70 g protein and 2.1 L water a day, as six 300 mL feeds through a Ryle's tube.
8. 8 · Safety points. Check tube position, head raised 30-45°, start slowly, plan swallowing trials.

Scoring tip: Start with 'if the gut works, use it' and draw the route table; the examiner looks for the 4-6 week rule.