Describe enteral tube feeding and indications for use. Provide an evidence-based rationale to support your response.

QUESTION

1. Describe enteral tube feeding and indications for use. Provide an evidence-based rationale to support your response.

2. Identify two potential client problems associated with receiving enteral tube feedings. Provide an evidence-based rationale to support your response.

3. Discuss assessment and priority nursing interventions in the care of a client receiving enteral tube feedings. Provide an evidence-based rationale to support your response

4. Identify potential complications of enteral nutrition and discuss the related pathophysiology. Provide an evidence-based rationale to support your response.

○ Discuss three priority nursing interventions that should be performed to manage each complication identified above. Provide an evidence-based rationale to support your response.

5. Discuss client goals and expected outcomes for clients receiving TPN.

6. Compare and contrast enteral tube feeding and TPN. Provide an evidence-base rationale to support your response.

ANSWER

Indications for enteral tube feeding include:

Inability to meet nutritional needs orally: ETF is recommended when a person is unable to consume adequate nutrition orally due to conditions such as dysphagia, neurological disorders, facial trauma, or severe anorexia. It ensures the delivery of essential nutrients, calories, and fluids to maintain optimal nutritional status.

Impaired gastrointestinal function: ETF can be used in individuals with conditions such as gastroparesis, intestinal obstruction, or short bowel syndrome. It helps bypass the affected portion of the gastrointestinal tract and allows for nutritional absorption.

Increased nutritional requirements: In certain medical conditions such as burns, severe infections, major surgeries, or critical illness, the body’s metabolic demands are increased. Enteral tube feeding can provide the necessary nutrients to support the body’s healing process and prevent malnutrition.

Chronic diseases: Individuals with chronic diseases like cancer, cystic fibrosis, or chronic obstructive pulmonary disease may experience increased energy expenditure and malnutrition. ETF can be used as a long-term nutritional support to optimize nutritional intake and improve overall health outcomes.

The rationale for enteral tube feeding is supported by numerous studies. Research has shown that enteral nutrition is associated with fewer complications and better clinical outcomes compared to parenteral nutrition (TPN) in most patients. It helps maintain the integrity and function of the gastrointestinal tract, prevents bacterial translocation, and preserves gut-associated immune function. Additionally, ETF is more cost-effective and generally easier to administer than TPN.

Potential client problems associated with receiving enteral tube feedings may include:

Aspiration: Aspiration occurs when the contents of the stomach or tube feeding formula enter the lungs, leading to respiratory complications. This can happen due to tube misplacement, inadequate tube securing, improper positioning of the patient, or gastric residual volume exceeding the safe limit. Aspiration pneumonia is a serious complication that can lead to respiratory distress and infection.

Gastrointestinal complications: Some individuals may experience gastrointestinal issues such as diarrhea, constipation, abdominal distension, or nausea and vomiting (Krishnan et al., 2013). These complications can be caused by various factors, including formula intolerance, inadequate fiber or fluid intake, rapid feeding rates, or bacterial overgrowth in the gastrointestinal tract.

The evidence-based rationale for these complications can be found in research studies and clinical guidelines. For example, a study by Metheny et al. (2018) found that aspiration events can occur in patients receiving enteral tube feedings, particularly if proper tube placement verification and positioning are not followed. Similarly, studies have identified factors such as formula composition, osmolality, and feeding rate that can contribute to gastrointestinal complications during enteral nutrition.

Assessment and priority nursing interventions in the care of a client receiving enteral tube feedings include:

Assessment

Regular monitoring of vital signs, respiratory status, and oxygen saturation to identify signs of aspiration or respiratory distress.

Assessing tube placement and verifying proper positioning using radiographic confirmation or other reliable methods.

Monitoring gastric residual volume to evaluate tolerance to feedings and prevent complications such as aspiration or delayed gastric emptying.

Assessing bowel movements and abdominal distension to identify gastrointestinal complications.

Priority nursing interventions

Ensure proper tube placement and securement to prevent accidental dislodgement or misplacement.

Maintain proper positioning of the patient, particularly elevating the head of the bed to a semi-Fowler’s position during feedings, to reduce the risk of aspiration.

Administer medications to promote gastrointestinal motility or alleviate symptoms such as nausea or constipation as prescribed by the healthcare provider.

Regularly assess and document bowel movements, abdominal distension, and other gastrointestinal symptoms to detect complications early and intervene promptly.

The evidence-based rationale for these interventions can be found in clinical practice guidelines and expert recommendations. For example, the American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines provide evidence-based recommendations for the management and care of patients receiving enteral tube feedings.

Potential complications of enteral nutrition include:

Diarrhea: Diarrhea can occur due to formula intolerance, osmotic effects, rapid feeding rates, bacterial contamination, or medications. It can lead to dehydration, electrolyte imbalances, and malabsorption.

Tube-related complications: These include tube dislodgement, tube obstruction, or tube site infection. Dislodgement can result in inadequate nutrition or aspiration, while obstructions can impede proper feeding. Infections at the tube insertion site can lead to local inflammation or systemic infection.

Metabolic complications: Imbalances in electrolytes, blood glucose levels, or liver function can occur. Electrolyte imbalances may result from inadequate or excessive administration of certain electrolytes in the enteral formula. Hyperglycemia or hypoglycemia can occur if the enteral formula is not properly adjusted to meet the patient’s glucose needs. Liver dysfunction can manifest as elevated liver enzymes or cholestasis due to long-term enteral nutrition.

Priority nursing interventions for managing these complications include:

Diarrhea:

Assess and document the characteristics of diarrhea, including frequency, volume, and consistency.

Collaborate with the healthcare team to evaluate the enteral formula and consider modifications if formula intolerance is suspected.

Monitor and maintain adequate hydration and electrolyte balance through oral or intravenous fluids, if necessary.

Administer medications or probiotics as prescribed to manage diarrhea or restore normal gut flora.

Tube-related complications

Ensure proper securing and placement of the feeding tube to minimize the risk of dislodgement.

Regularly assess the tube insertion site for signs of infection, such as redness, swelling, or purulent drainage. Cleanse the site as per institutional protocols.

Monitor the patency of the tube by flushing it with water or prescribed solutions before and after each feeding or medication administration.

Collaborate with the healthcare team for timely interventions in case of tube obstruction, such as enzymatic solutions or replacement of the tube.

Metabolic complications

Monitor and document blood glucose levels regularly, especially in patients with diabetes or those at risk of developing hyperglycemia.

Assess liver function through laboratory tests and report any abnormalities to the healthcare provider.

Collaborate with the healthcare team to adjust the enteral formula composition or rate to address specific metabolic needs.

Educate the patient and caregivers about signs and symptoms of metabolic complications and the importance of regular monitoring.

The rationale for these nursing interventions is supported by evidence-based practice guidelines and research studies (Liu et al., 2022). For example, the ASPEN guidelines provide recommendations for the prevention and management of diarrhea, tube-related complications, and metabolic complications in patients receiving enteral nutrition.

Goals and expected outcomes for clients receiving Total Parenteral Nutrition (TPN) include

Improved nutritional status: The primary goal of TPN is to provide complete nutrition to patients who are unable to meet their nutritional needs orally or via enteral feeding. The expected outcome is achieving and maintaining optimal nutritional status, including adequate macronutrient and micronutrient intake, normal weight, and appropriate laboratory markers of nutrition.

Prevention of complications: TPN aims to prevent complications associated with malnutrition, such as infection, delayed wound healing, and organ dysfunction. The expected outcome is the absence or reduction of complications related to malnutrition, improved wound healing, and overall organ function.

Transition to oral or enteral nutrition: TPN is often used as a temporary measure, and the goal is to transition the patient to oral or enteral nutrition as soon as feasible. The expected outcome is the ability to tolerate oral or enteral intake and gradual reduction or discontinuation of TPN while maintaining adequate nutrition.

The evidence-based rationale for these goals and expected outcomes is supported by research studies and clinical practice guidelines. For example, a systematic review by Braunschweig et al. (2019) found that TPN can effectively improve nutritional status in patients who cannot receive nutrition orally or via enteral feeding. Additionally, studies have shown that appropriate use of TPN can reduce the incidence of complications and facilitate the transition to oral or enteral nutrition when appropriate.

Comparing enteral tube feeding (ETF) and Total Parenteral Nutrition (TPN)

ETF and TPN are both methods of providing nutrition to individuals who cannot meet their nutritional needs orally. However, they differ in terms of route of administration, indications, and associated risks.

Enteral tube feeding involves delivering nutrition directly into the gastrointestinal tract through a tube. It is preferred when the gastrointestinal system is functional and can tolerate enteral intake (Adeyinka, 2022). ETF is associated with several advantages, including preservation of gut integrity and immune function, cost-effectiveness, and ease of administration. It is the preferred method when the gastrointestinal tract is functional and the patient can tolerate enteral intake.

On the other hand, Total Parenteral Nutrition (TPN) involves delivering nutrition directly into the bloodstream via a central venous catheter. It is used when the gastrointestinal tract is non-functional or cannot tolerate enteral intake. TPN bypasses the digestive system entirely, providing complete nutrition. However, TPN carries higher risks, including infection, metabolic complications, and catheter-related complications. It is typically reserved for patients with severe gastrointestinal dysfunction or those who cannot tolerate enteral nutrition.

The evidence-based rationale for choosing ETF over TPN, when possible, is supported by numerous studies and clinical guidelines. Research has consistently shown that ETF is associated with fewer complications and better clinical outcomes compared to TPN in most patients. Enteral nutrition helps maintain gut function, prevents bacterial translocation, and supports the body’s immune response. Additionally, ETF is more cost-effective and easier to administer, making it the preferred choice whenever feasible.

In conclusion, enteral tube feeding is a method of providing nutrition through a tube inserted into the gastrointestinal tract. It is indicated when oral intake is inadequate or gastrointestinal function is impaired. Potential complications of enteral nutrition include aspiration, gastrointestinal issues, diarrhea, tube-related complications, and metabolic imbalances. Nursing interventions focus on proper tube placement, positioning, monitoring, and prompt intervention to manage complications. Client goals for TPN include improved nutritional status, prevention of complications, and transitioning to oral or enteral nutrition. ETF is preferred over TPN whenever possible due to its advantages in preserving gut function and immune response, cost-effectiveness, and ease of administration.

References

Adeyinka, A. (2022, December 26). Enteric Feedings. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK532876/ 

Krishnan, B., Babu, S., Walker, J., Walker, A. M., & Pappachan, J. M. (2013). Gastrointestinal complications of diabetes mellitus. World Journal of Diabetes, 4(3), 51. https://doi.org/10.4239/wjd.v4.i3.51 

Liu, D., Liu, Q., & Wen, X. (2022). Related Factor Analysis and Nursing Strategies of Diarrhea in Critically Ill Patients with Enteral Nutrition. Emergency Medicine International, 2022, 1–8. https://doi.org/10.1155/2022/8423048