Refeeding Syndrome What is it?

This week I had a student with a client who had not eaten in over 10 days, his only nutrient intake was through IV D5W and he had been decompressed by NG tube for the majority of the time. The Docs were considering putting him on TPN and sending him home with HC Nurses and dieticians overseeing the TPN. Instead they trialed him on oral intake with Boost which he was taking very slowly and seemed to be tolerating well.

I suggested the student research re-feeding syndrome so that she could better understand it and the negative impact it can have on a person who has been malnourished for an extended period of time. Yesterday she was diligently trying to read an article on re-feeding syndrome so that she could better understand this phenomenon but was having trouble weeding through all of the information. The student wanted to describe the syndrome as a type of ‘shock’ to the system…. however I was not too keen on using that term as the actual syndrome is not considered part of the ‘shock’ syndromes but with the electrolyte imbalances and fluid shifts it could lead to Hypovolemic shock, or dysrythmias, resulting in Cardiogenic shock. She asked me if I could explain it to her in simplified terms……

And that’s when I realized that I could not…. in fact I too struggled with explaining all of the intricate processes that were involved in the compensatory mechanisms that came into play when a person was heading into the state of malnourishment and then trying to describe the effects of trying to re-feed that person and reverse all of the compensatory mechanisms in a slow and deliberate manner. I kept saying, it’s all chemistry, and I tried to draw a picture of a cell and talk about concentration gradients, solutes and solvents, nitrogen balance, electrolyte balance…… and as I did I found myself getting more befuddled along with the student…..

And then of course as I sometimes do I found myself heading off on a tangent about dumping syndrome and electrolyte balance etc…. and that muddied the waters even further!

So now I had opened two of Pandora’s boxes…. how to explain re-feeding syndrome AND how to explain dumping syndrome…. 

So Now I am going to try and do my best to better understand re-feeding syndrome so that I can better explain it.

I will be trying to create a flow chart or a bullet point by point explanation for now I will post a couple of great you-tube videos that describe the syndrome fairly well and provide information on how to reduce the occurrence of this syndrome along with some nursing assessments and interventions when caring for the client as risk of re-feeding syndrome.

Choosing the right injection site

Recently I had a fellow RN ask me to review with her the process giving a verntrogluteal intramuscular injection. She had been using the less optimal dorsalgluteal site, and even though i generally on use the ventrogluteal site I realized that teaching this technique to another professional would require my absolute confidence in my own ability to landmark. To that end I have been diligently reviewing the current practice guidelines and looking for quality resources to help guide practice.

Here are some of the resources I have found so far

Cocoman & Murray


Save inj tec6



Lesson Planning

Components of a Lesson Plan: Rationales for 5 Selected Components



            I believe that planning is essential to designing quality instruction. It has been my experience that when I create a well thought out lesson plan, class tends to run more smoothly and I am able to cover the important points within the allotted time. The SABES/ACL lesson planning guide covers a variety of the advantages from creating a lesson plan (2008). Three of which I think will especially help me in my practice, first a lesson plan (LP) helps deepen the instructors understanding of the material being covered, second, LP’s provide a record of what was covered in the lesson and third, LP’s can be shared, re-used, re-structured and become better defined as time goes by.

Creating a Positive Learning Environment

           Creating a positive learning environment is ideal as I believethat environment affects learning. In a safe and positive environment students are more responsive and learning strategies are more effective. I aim to cultivate a liberal and encouraging environment while still maintaining order to promote a sense of safety. I nurture trust by assuring the students that as long as they are honest and forthcoming, there is virtually nothing that cannot be dealt with. In the classroom I discourage negative comments while encouraging active listening, respectful discussion and collaborative problem solving.

Instructional Process/Strategies

            I believe instructional strategies and processes are essential resources; how the material is presented is as important as the information itself.  I have found that using a variety of instructional strategies keeps the students engaged while addressing an assortment of learning styles. The SABES/ACL lesson planning guide covers a variety of instructional strategies from brainstorming, small group work, modeling and role playing, to setting up learning stations (2008). I plan to continue to use successful strategies while looking for new and exciting strategies, in the hope of providing students with a stimulating and valuable learning experience.


            Media covers everything from slide shows, videos, props and demonstration equipment to handouts. As an instructor I need to know what type of media I have access to, so that I can plan accordingly. Consideration for student access is also important, if a student cannot access a computer then having the class material only available in that format would be unreasonable. If I am well prepared, with all of the media related tools and resources needed, then I can use class time more wisely than if I had not prepared.


            Assessment can be seen in two ways, the first being what tools and measures you will use to assess students’ learning and the second being the assessment of the class/instruction itself. In the case of student assessment a detailed overview of the assessment process and marking criteria provide the student with a clear understanding of what they are expected to achieve and how this will be measured. The success of the lesson and of the instruction is inherently related to the success of the student. Students will be provided a detailed explanation of the assessment process and invited to provide feedback on the instructional approach.


System for Adult Basic Education Support (2008). Lesson Planning Resource Guide. Retrieved from       

Related Article

Online Resources

 Link to S-BAR Lesson Plan I Constructed for Nursing Students

Links to Other Lesson Plan Templates