The report has been prepared to focus Enteral and Parenteral nutrition given to patients. The report shows various methods the nutrition can enter the human body. This report focuses on the difference between enteral and parenteral feeding. The indications section gives insight as to when enteral or parenteral feeding is given to individual. It focuses on various nursing considerations that need to be taken care for preventing medical complications during enteral and parenteral feeding. Finally the report highlights the medical complications that occur during enteral and parenteral feeding.
A balanced diet is the key factor for achieving good health and it comprises of healthy and diverse foods. A healthy diet can prevent many common health problems. The diet of each individual is largely governed by the palatability of foods. Dietitians provide healthy dietary advice and management to each individual and institutions. Various researches have proved that a poor diet may results in various health problems. Healthy diet contains vital nutrients that help in proper metabolic functioning of the body. The body requires fuel to provide energy for proper organ functioning, growth and cellular metabolism and repair. The lack of good nutrients and unhealthy intake of food results in building up of toxins inside the body and hence leading to various chronic diseases in the long run.
Following are the methods by which the nutrition can enter the human body-
Oral Nutritional intake route
Normally the fluid only enters the body through mouth. The adult drinks approx 2-3 litres of fluid per day directly. Indirectly the fluid enters the body through the water content found in the food or generated by cellular metabolism of the ingested foods. During the cellular metabolism the food is broken down in stomach and absorbed in the bowel. The absorbed food is transported by blood throughout the body.
Enteral Nutrition intake route
The Enteral nutrition is also referred as Tube feeding. In Tube feeding special liquid food which composes of carbohydrates, vitamins, proteins and minerals are injected into the body with the help of tube. In enteral nutrition the fluid is given through the tube placed in the small intestine, the stomach, or the nose. When the fluid is passed through the nose it is called as nasogastric tube or nasoenteral tube. If the tube is injected into the stomach that goes through the skin it is called as gastrostomy or percutaneous endoscopic gastrostomy (PEG). If the tube is passed into the small intestine it is called as jejunostomy tube or percutaneous endoscopic jejunostomy (PEJ).
Parenteral Nutrition intake route
In Parenteral nutrition (PN) the normal process of eating and digestion is bypassed and individual is given the nutrition intravenously. The nutrition given intravenously contains glucose, lipids, amino acids, salts and vitamins. Following are two types of Parenteral Nutrition -
- Partial parenteral nutrition - In this process only a part of daily nutrition is given intravenously in addition to oral intakes. The hospitalized patients are given the solution containing amino acid or dextrose by this method.
- Total parenteral nutrition (TPN) - In this method oral intake of food is also prohibited and nutrition is supplied to the body only through veins. TPN can be given to patient either in hospital or at home. TPN solutions are highly concentrated and can result in thrombosis of peripheral veins hence central venous catheter is generally required
This process of injecting nutrition with the help of tube is followed for patients who are sedated, unconscious or under ventilation. Enteral nutrition provides a partial nutrition support if the oral intake in insufficient. People suffering from eating and swallowing impairment, stroke, motor neuron disease sever weight loss, nausea are unable to take the required nutrition orally. Such patients need to be given additional nutrition through tube feeding.
The process of giving the nutrition intravenously is followed for patients who suffer from severe diarrhea or vomiting, gastrointestinal obstruction or enterocutaneous fistula. The malfunctioning of the gut mass below minimal leads to intestinal failure resulting in reduced intake of nutrition and such patients need to be kept under TPN (Total Parenteral Nutrition). Patients showing moderate or severe malnutrition, abdominal sepsis, acute pancreatitis, prolonged ileus, severe inflammatory bowel disease or major trauma and burns need to be kept on parenteral nutrition.
Nurses must be aware of clinical outcomes of using parenteral and enteral nutrition and must be updated with the clinical issues related to nutritional management. Nurses should be competent enough to provide correct clinical judgment in complicated situation preserving safety and needs of the patients. Every nutritional support is associated with gastrointestinal, mechanical, infectious risk or metabolic complications, hence thorough assessment of patients need to be done to prevent complications and provide faster health recovery. The patients need to be closely monitored while receiving the nutrition through enteral or parenteral means to identify the potential problems associated with each.
Nurses should be aware with the patient's medical history which will help in selection of appropriate enteral nutrition product and hence reducing or preventing malabsorption complications. Aspiration complications can be reduced in tube feeding by using of small-bowel feeding tubes, periodic assessment of gastric residuals, promotility agents, and keeping the head of the bed elevated. Small-bore tube and very attentive nursing care helps minimize many problems related to tube feeding. The tube placement need to be done by trained personnel and should closely monitor after post-placement will reduce these complications. Tube clogging can be prevented by routine flushing and clean technique should be used to minimize formula contamination.
The enteral nutrition feeding is efficient as well as cost effective but it is still associated with complications like metabolic, mechanical and gastrointestinal.
- Gastrointestinal complications - Gastrointestinal are the most common complications experienced by the patients receiving enteral tube feeding. 20% of patients approximately experience vomiting and nausea and hence increasing the risk of aspiration during enteral tube feeding. Diarrhea is yet another symptom developed by patients receiving tube feeding. Due to decreased fluid intake, lack of dietary fiber, inactivity or decreased bowel motility results in constipation.
- Mechanical complications - One of the serious complications of enteral feeding is pulmonary aspiration which can become life-threatening for patients. There are various risk factors associated with aspiration like decreased level of consciousness, neurologic injury, GI reflux or diminished gag reflex. Improper placement or presence of tube leads to complications like tracheal, bleeding, or parenchymal perforation. The presence of tube can lead to lower and upper airway complications. Tube clogging happens more frequently with viscous and intact protein products.
- Metabolic complications - Enteral feeding is associated with imbalance of hhyperglycemia and fluid and electrolyte complications. In refeeding syndrome there is minor decrease in circulating levels of magnesium, potassium and phosphate. The refeeding syndrome, adversely affect the organ system and also result in cardiac dysrhythmias, acute respiratory failure, heart failure, coma, nephropathy, paralysis and liver dysfunction.
Parenteral nutrition showed greater level of complications as compared to enteral feeding like blood clots, degeneration of organs in the intestinal tract and damage to blood vessels.
- Re-feeding syndrome - During refeeding syndrome the intracellular electrolyte in particular phosphate levels are depleted irrespective if normal serum concentrations. Feeding results in electrolyte disturbances resulting in other complications like coma, cardiac failure, rhabdomyolysis, hypotension, or respiratory failure.
- Catheter-related complications - The immediate complications observed are related to insertion and include medical complications arrhythmias, pneumothorax or haemothorax, haemorrhage or cardiac tamponade. The long term complications observed are pleural or pericardial effusion, thrombosis and pulmonary embolism or sub acute bacterial endocarditic.
- Infection - There are high chances of developing infection during total parenteral nutrition. Approximately 15% of mortality rate has been observed due to catheter related infection. Proper care should be taken to prevent infection.
- Liver and gallbladder dysfunction - Approximately 90% patients develop mild cholestasis resulting in improper functioning of liver and gallbladder.
Reference and Bibliography
- Text referencing: Lewi's Medical-surgical nursing by Brown & Edwards