Ch. 16 - Enteral Nutrition

Nutrition Exam 2

What is enteral nutrition (EN)?

Enteral nutrition is the delivery of nutrients directly into the gastrointestinal tract(GI) tract through a feeding tube when a patient cannot safely eat enough by mouth but has a functioning GI tract

When is enteral nutrition preferred over parenteral nutrition (PN)?

When the GI tract is functional, because it helps maintain gut integrity and has fewer complications than PN

What are common reasons a patient may need enteral nutrition?

Stroke with dysphagia

Neurologic disorders

Head and neck cancer

Severe illness or trauma

Inability to meet nutritional needs by mouth

What are common types of enteral feeding tubes?

Nasogastric (NG)

Nasojejunal (NJ)

Gastrostomy (G-tube/PEG)

Jejunostomy (J-tube)

What is the difference between a PEG tube and an NG tube?

NG tube: Inserted through the nose into the stomach; typically for short-term use

PEG tube: Placed directly into the stomach through the abdominal wall; intended for long-term use

What are the four common methods of enteral feeding?

Bolus

Intermittent

Cyclic

Continuous

What is a bolus feeding?

A larger amount of formula is given over a short period (often using a syringe), several times a day

Which patients commonly receive bolus feedings?

Stable patients with gastrostomy tubes who can tolerate larger feedings

What is an intermittent feeding?

Formula is delivered over 20-60 minutes, several times throughout the day, usually with a feeding pump or gravity

What is a continuous feeding?

Formula is delivered slowly over 24-hours using a feeding pump

Which patients commonly receive continuous feedings?

Critically ill patients

Patients with poor tolerance to larger feedings

Patients receiving jejunal feedings

What is a cyclic feeding?

Formula is delivered over a set period, often overnight, allowing the patient to eat by mouth during the day if appropriate

Which feeding method is most likely to cause gastrointestinal intolerance?

Bolus feeding, because a larger volume is delivered over a short time

Which feeding method is generally best tolerated?

Continuous feeding

Which feeding method most closely mimics normal meal patterns?

Bolus feeding

Which feeding method is commonly used overnight to encourage daytime oral intake?

Cyclic feeding

Why are feeding tubes flushed?

Maintain tube patency

Prevent clogging

Provide hydration

Clear the tube before and after feedings or medications

What is typically used to flush a feeding tube?

Water (following facility policy and patient needs)

When should feeding tubes generally be flushed?

Before and after medications

Before and after intermittent or bolus feedings

At regular intervals during continuous feedings, according to policy

What is the first step before giving medications through a feeding tube?

Verify correct tube placement and ensure the tube is appropriate for medication administration according to facility policy

Should medications be mixed directly into th tube feeding formula?

No, medications should generally be administered separately to avoid interactions and tube clogging

Why should medications be given one at a time through a feeding tube?

To reduce the risk of drug interactions and tube obstruction

What should be done between medications?

Flush the tube with water according to facility policy

Why are extended-release or enteric-coated tablets generally not crushed for tube administration?

Crushing them changes how the medication is released or absorbed and may increase the risk of adverse effects or reduce effectiveness

What is tube feeding intolerance?

The inability of the gastrointestinal tract to adequately tolerate enteral nutrition, resulting in gastrointestinal symptoms or poor nutrient delivery

What are the common signs and symptoms of tube feeding intolerance?

Nausea

Vomiting

Abdominal distention (bloating)

Abdominal cramping

Diarrhea

Constipation (can occur in some patients)

Patient discomfort or fullness

Which feeding method is most commonly associated with gastrointestinal intolerance?

Bolus feedings, because a large volume enters the stomach over a short period

Why are continuous feedings generally better tolerated?

The formula is delivered slowly and steadily, placing less stress on the gastrointestinal tract

What factors can contribute to diarrhea in patients receiving tube feedings?

Rapid infusion

Formula intolerance

Certain medications (especially antibiotics)

Infection

Contaminated formula or equipment

What should the healthcare team assess if a patient develops diarrhea during tube feeding?

Feeding rate, formula, medications, hydration status, and possible infection rather than assuming the formula is the only cause

What can contribute to constipation in patients receiving enteral nutrition?

Inadequate water intake

Immobility

Low fiber intake (depending on the formula)

Certain medications

What is aspiration?

The inhalation of food, liquid, saliva, or gastric contents into the airway or lungs

What is the most serious complication of aspiration?

Aspiration pneumonia

Which patients receiving tube feedings are at increased risk for aspiration?

Patients with impaired consciousness

Patients with dysphagia

Patients with neurological disorders

Patients who must remain lying flat

Patients with impaired cough or gag reflexes

What position should a patient be in during enteral feedings?

The head of the bed should be elevated 30-45 degrees, unless contraindicated

How long should the head of the bed generally remain elevated after a feeding?

At least 30-60 minutes after a bolus feeding (follow facility policy and provider instructions)

Why is elevating the head of the bed important?

It helps reduce the risk of reflux and aspiration

Why is verifying feeding tube placement important?

To ensure the formula is delivered into the intended location rather than the airway

Why should patients be monitored during enteral feedings?

To identify signs of intolerance, aspiration, or tube-related complications early

What symptoms may suggest aspiration?

Coughing during feeding

Choking

Difficulty breathing

Decreased oxygen saturation

Crackles on lung examination

Fever (may develop later if pneumonia occurs)

What should the nurse do if aspiration is suspected?

Stop the feeding

Assess the patient’s airway, breathing, and oxygenation

Notify the healthcare provider and follow facility protocols

Why is good oral care important for tube0fed patients?

It reduces oral bacteria, which may lower the risk of aspiratoin pneumonia if aspiration occurs

A patient receiving bolus tube feedings develops nausea, abdominal distention, and vomiting. What is the most likely problem?

Tube feeding intolerance

A nurse is preparing to start a tube feeding. What is the priority intervention?

Verify tube placement according to facility policy and position the patient with the head of the bed elevated

A patient receiving enteral nutrition suddenly begins coughing and becomes short of breath during the feeding. What should the nurse do first?

Stop the feeding immediately, assess the patient, and evaluate for possible aspirations