25) Joseph is a 45-year-old male who works as a roofer for a.

25) Joseph is a 45-year-old male who works as a roofer for a building contractor. He fell from a third-floor roof, suffering from multiple fractures and a severe head injury. He has been in a comatose state ever since. Unable to take food orally, a nasogastric tube was inserted for feeding. Full strength Ensure at 50 cc/hour was ordered initially, and then advanced to 75 cc/hr after the first 24 hours. Joseph had mild diarrhoea when the tube feeding was first initiated, but this resolved after 2 days. At the time of admission, Joseph was 5’8″ tall and weighed 82 kg, his usual body weight.

One month later, Joseph who has no gag reflex, was transferred to an extended care facility. By this time, he weighed 71kg. A PEG line was inserted, and full-strength Ensure Plus was begun at 65cc/hr with the goal of anabolism (weight gain). The formula was tolerated well. However, after several weeks, constipation developed. The formula was changed to Jevity at 75cc/hr. The protocol was also changed from a continuous drip to bolus feedings to equal the amount provided by the continuous drip.

Part A

1. Jevity comes in a bag of 500ml.  How many hours will this bag take to run through?

2. Give two reasons why a PEG tube would be used.

Part B

1. Give two complications of a PEG. (1 mark)

2. List two signs and symptoms for each complication.

Part C

Joseph is complaining of abdominal pain 8/10 with no effect from Panadol. Morphine elixier 5gm is ordered stat.  Morphine strength is 10mgs in 10mls.

1. What schedule drug is morphine?

2. How many mls would you give?

Part D

Erythromycin suspension 500mg is ordered on QID.

1. What is the schedule of Erythromycin?

2. In stock is Erythromycin 250mg in 5mls.  Joseph is ordered 500mg.  How many mls is required every 6 hours?

Part E

10 minutes post administration of erythromycin Joseph looks pale and clammy, RR increases to 40 and he suddenly collapses.  What steps would you do in this medical emergency?