| Course | NS490 Medical Nutrition Therapy II |
|---|---|
| Unit | Unit 4 |
| Paper type | Enteral regimen worksheet |
| Length | About 610 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | BS in Nutrition Science |
| Updated | October 2026 |
Free sample paper for NS490 Unit 4
Line by Line to 65 mL an Hour: A Unit 4 Enteral Regimen Worksheet for a Woman Fed by Nasogastric Tube After Stroke
[Student Name]
Purdue University Global
NS490: Medical Nutrition Therapy II
Unit 4 Enteral Regimen Worksheet
[Instructor Name]
[Date]
The patient and her values are composite; the neurology nutrition guideline, the stroke feeding trial and the enteral safety recommendations cited are real.
Patient Data
Evelyn, 72, had a left middle cerebral artery stroke three days ago. She failed a bedside swallow screen and a follow-up assessment by speech-language pathology. A nasogastric tube was placed and its position confirmed by X-ray. She has no diabetes or kidney disease.
Height 163 cm. Weight 62 kg, measured on admission. BMI 23.3.
Why Feed by Tube Now
Guidance on nutrition in neurology recommends early enteral nutrition for stroke patients with severe dysphagia, using a nasogastric tube in the first weeks (Burgos et al., 2018). In a large trial of dysphagic stroke patients, early tube feeding was associated with a reduction in deaths that did not reach statistical significance, and nasogastric feeding in the early period was associated with better outcomes than early gastrostomy (FOOD Trial Collaboration, 2005).
Step 1: Goal Energy
Using 25 kcal per kilogram: 25 times 62 equals 1,550 kcal per day.
Step 2: Goal Protein
Using 1.2 g per kilogram: 1.2 times 62 equals 74.4 g, rounded to 74 g per day.
Step 3: Goal Fluid
Using 30 mL per kilogram: 30 times 62 equals 1,860 mL per day.
Step 4: Formula
A standard polymeric formula providing 1.2 kcal per mL, 55.5 g protein per liter and 81 percent free water is chosen. She has no condition requiring a specialized formula.
Step 5: Volume and Rate
1. Volume for energy: 1,550 divided by 1.2 equals 1,292 mL, rounded to 1,300 mL.
2. Hours of feeding: 20 hours, allowing 4 hours off for therapy, bathing and imaging.
3. Rate: 1,300 divided by 20 equals 65 mL per hour.
Step 6: What 65 mL an Hour Delivers
1. Energy: 1,300 times 1.2 equals 1,560 kcal.
2. Protein: 1.3 liters times 55.5 equals 72.2 g, about 98 percent of the protein goal.
3. Free water from formula: 1,300 times 0.81 equals 1,053 mL.
Delivered protein of 72 g sits just under the 74 g goal, close enough to start, and the gap is noted so it can be closed with a protein modular if intake records show she is falling short.
Step 7: Water Flushes
1. Fluid still needed: 1,860 minus 1,053 equals 807 mL.
2. Routine flushes: 30 mL every 4 hours equals 180 mL.
3. Additional free water: 807 minus 180 equals 627 mL, given as 150 mL four times a day, or 600 mL.
4. Total water: 1,053 plus 180 plus 600 equals 1,833 mL, within 2 percent of the goal.
5. Medication flushes are added by nursing as ordered.
Step 8: Advancement
Start at 20 mL per hour and increase by 15 mL per hour every 6 hours as tolerated, reaching 65 mL per hour on day 2.
Safety Measures
Evelyn should be positioned with her upper body elevated to 30 degrees or more while formula runs and for an hour after it stops, check tube position before use, and follow facility policy on flushing and medication administration, as enteral safety recommendations describe (Boullata et al., 2017).
Monitoring
Daily weight for the first week, then twice weekly. Intake and output records daily. Electrolytes, including phosphate, daily for three days. Signs of intolerance such as vomiting or abdominal distension. Swallow reassessment by speech-language pathology to plan a return to oral intake.
References
Boullata, J. I., Carrera, A. L., Harvey, L., Escuro, A. A., Hudson, L., Mays, A., McGinnis, C., Wessel, J. J., Bajpai, S., Beebe, M. L., Kinn, T. J., Klang, M. G., Lord, L., Martin, K., Pompeii-Wolfe, C., Sullivan, J., Wood, A., Malone, A., Guenter, P., & ASPEN Safe Practices for Enteral Nutrition Therapy Task Force. (2017). ASPEN safe practices for enteral nutrition therapy. Journal of Parenteral and Enteral Nutrition, 41(1), 15-103. https://doi.org/10.1177/0148607116673053
Burgos, R., Bretón, I., Cereda, E., Desport, J. C., Dziewas, R., Genton, L., Gomes, F., Jésus, P., Leischker, A., Muscaritoli, M., Poulia, K.-A., Preiser, J. C., Van der Marck, M., Wirth, R., Singer, P., & Bischoff, S. C. (2018). ESPEN guideline clinical nutrition in neurology. Clinical Nutrition, 37(1), 354-396. https://doi.org/10.1016/j.clnu.2017.09.003
FOOD Trial Collaboration. (2005). Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): A multicentre randomised controlled trial. The Lancet, 365(9461), 764-772. https://doi.org/10.1016/S0140-6736(05)17983-5
NS490 Unit 4 instructions, in plain terms
In the fourth NS490 unit the prompt supplies a patient who cannot eat safely and asks for a full enteral regimen. Students set goals for energy, protein and fluid, choose a formula and translate the totals into a rate and schedule. Each calculation should appear with its working, not just the answer. State the weight used and why. Describe the formula by its energy density and protein content, with values from the product information. Work out the hours of infusion, the hourly rate and what that rate actually delivers. Free water from the formula is subtracted from the fluid goal, and the remainder becomes flushes. Add a starting rate and how it will advance. Safety steps such as head-of-bed elevation belong in the worksheet. Close with monitoring. Worksheets of this kind are usually two to four pages, with references in APA 7.
How the NS 490 Unit 4 example is put together
The sample opens with the patient's data and a short case for feeding by tube now rather than waiting. Steps 1 to 3 set goal energy, protein and fluid from her weight, each in a few lines of multiplication. Step 4 chooses a standard 1.2 kcal per mL formula and lists its protein and water content. Step 5 converts the energy goal into a daily volume and divides it over 20 hours to reach 65 mL an hour. Step 6 reverses the arithmetic to show what that rate delivers, and the highlighted sentence compares 72 g of delivered protein with the 74 g goal. Step 7 calculates free water and sets flushes. Step 8 gives the starting rate and advancement. Safety measures cover tube position checks and positioning, and monitoring lists weights, intake, electrolytes and stools.
Where the points sit in the NS490 Unit 4 rubric
Enteral worksheets are judged mainly on calculation accuracy and whether each figure can be traced to the one before it. A correct final rate with no working earns little. Goals need a stated basis, such as kilograms of actual or adjusted weight. The formula choice should fit the patient, with a reason given. Checking what the chosen rate delivers, rather than assuming the goal is met, earns credit because it catches shortfalls. Free water and flushes are often a separate line in the rubric. Advancement and safety steps show practical readiness for a ward. Monitoring must include specific measures. Neat layout and consistent units matter more in a worksheet than in a paper. Accurate sources in APA 7 complete the grade, and product values should come from the manufacturer rather than memory.
NS490 Unit 4 help: mistakes that cost points
The commonest worksheet slip is forgetting to check what the rate actually provides, so a protein shortfall goes unnoticed. Others mix units, such as kcal per mL and kcal per liter, and the totals drift. Free water is sometimes ignored, or the full fluid goal is given as flushes on top of the formula. Some writers choose a specialized formula without a reason. Rates are calculated over 24 hours when the order allows interruptions for care. Advancement is left out, which matters on the first day. Monitoring sections name labs without frequency. If your patient data are ready but the steps between goal and rate keep giving different answers, a writer can lay out your regimen line by line from your own case.
Get an NS490 Unit 4 example written to your instructions
A bolus or cyclic schedule, a fluid restriction or a set formulary may shape the tube feeding case issued for NS490 Unit 4. Include every value in the case, any formulary your section provides, and the rubric. In 24-48h each step arrives computed from the ones before it, with free water and advancement written out, and a first custom sample is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NS490 Unit 4 questions, answered
Should the worksheet use a specific formula brand?
Only if the prompt supplies a formulary or asks for one. Otherwise describe the formula by its properties and, if helpful, name one product that meets them, with its values taken from the manufacturer's current data. The marks sit in the justification, so a brand name without reasons earns less than a well-argued profile.
Are gastric residual volumes part of the monitoring?
Follow the case and the facility policy it describes. Current critical care guidance has moved away from routine residual checks, and some ward policies have followed, while others still require them. A worksheet that notes the policy it applies and acknowledges the debate shows judgment without contradicting the setting your case describes.
How is free water calculated from the formula?
Multiply the daily formula volume by the water fraction the product lists, typically around 80 percent for standard densities and less for concentrated ones. Subtract that from the fluid requirement, then divide the remainder into flushes on a schedule. Count medication flushes too, or the patient may receive more water than intended.
Where can I find a free NS490 Unit 4 sample paper?
You can read a complete NS490 Unit 4 enteral regimen worksheet on this page, calculating goals, formula, a 65 mL hourly rate, free water and flushes for a woman fed by nasogastric tube after a stroke.
Why does the NS490 Unit 4 sample accept 72 g of protein?
The delivered 72 g sits just below the 74 g goal, close enough to start safely. The worksheet notes the gap so a protein modular can be added if intake records show she stays short.