A severely malnourished client begins tube feeding. Twenty-four hours later, phosphorus falls from 3.4 to 1.2 mg/dL and the client develops weakness and paresthesias. Complete the nurse’s interpretation and priority plan.
Drop-down Cloze
Choose your responses, then check the answer.
Explanation
A substantial phosphorus decrease soon after calorie reintroduction in a severely malnourished client strongly supports refeeding syndrome. The nurse promptly notifies the team, obtains or confirms cardiac monitoring and repeat electrolytes, and assesses for neuromuscular, cardiac, respiratory, and fluid complications. Treatment commonly includes electrolyte replacement, thiamin, and temporary calorie or dextrose reduction with cautious advancement according to severity and the prescribed plan.
Correct Answer Recognize refeeding syndrome, escalate with cardiac and electrolyte monitoring, and anticipate electrolyte-thiamin replacement with reduced or held calorie advancement.
Why It Fits The timing, severe phosphate decline, malnutrition, and new neuromuscular symptoms form one coherent syndrome.
Clinical Picture Insulin-driven intracellular shifts can lower phosphorus, potassium, and magnesium and cause arrhythmia, weakness, respiratory failure, neurologic change, and fluid imbalance.
Memory Link Feed starts, electrolytes shift, organs struggle.
NCLEX Rule Do not respond to a severe post-feeding electrolyte decline by advancing calories unchanged.
Why the Alternatives Fail Dumping syndrome does not explain severe hypophosphatemia; isolated dehydration or food intolerance does not fit the electrolyte timing and symptoms.
Sources
1ASPEN Consensus Recommendations for Refeeding Syndrome
22026 NCLEX-RN Test Plan
Calories were recently reintroduced. The nurse reviews phosphorus, potassium, magnesium, glucose, fluid balance, cardiac rhythm, and thiamin administration with the interprofessional team.
Refeeding syndrome — Metabolic and electrolyte disturbances that can occur when calories are reintroduced after severe undernutrition.
Hypophosphatemia — An abnormally low serum phosphorus level that can impair neuromuscular, cardiac, and respiratory function.