Page 425 - Nutrition Essentials for Nursing Practice

C H A P T E R 1 5 Feeding Patients: Oral Diets and Enteral and Parenteral Nutrition 413

NURSING PROCESS: Enteral Nutrition Support (continued)

Client Outcomes Planning
Nutrition Therapy
Client Teaching The client will
■ Meet calorie and protein goals via combination of oral and tube feeding
Evaluate and Monitor ■ Be free of any signs or symptoms of aspiration and other complications
■ Discontinue tube feedings when oral intake is consistently 2⁄3 of calorie

and protein goal

Nursing Interventions

■ Administer tube feeding as ordered
■ Encourage oral intake
Instruct the client
■ On the importance of tube feedings for supplemental nutrition until oral

intake meets 75% of goal
■ On the signs and symptoms of intolerance of tube feeding and to alert

the nurse if any problems arise
■ Not to adjust the flow rate unless otherwise instructed
■ On formula preparation, administration, and monitoring as well as the

rationales and interventions for tube-feeding complications, if home
enteral nutrition is indicated

Evaluation

■ Monitor weight
■ Monitor flow rate and administration
■ Monitor for signs and symptoms of intolerance: aspiration, complaints

of nausea, bloating, high gastric residuals, and diarrhea

PARENTERAL NUTRITION

Parenteral Nutrition Parenteral nutrition (PN) was developed in the 1960s when researchers from the
(PN): the delivery University of Pennsylvania discovered how to deliver nutrients into the bloodstream
of nutrients by vein; via central venous access, thereby bypassing the GI tract (Koretz, 2007). Using a
parenteral literally large-diameter central vein allows for the infusion of a nutritionally complete, hypertonic
means “outside the formula because it is quickly diluted; smaller veins are not able to handle such concen-
intestinal tract.” trated solutions. PN is a life-saving therapy in patients who have a nonfunctional GI
tract, such as in the case of obstruction, intractable vomiting or diarrhea, short bowel
syndrome, or paralytic ileus. In practice, PN is used for other clinical conditions, such as
critical illness, acute pancreatitis, liver transplantation, and AIDS, and in cancer patients
receiving bone marrow transplants.

When PN was first introduced, it was widely and enthusiastically embraced as state-
of-the-art therapy. The prevailing school of thought was that “if some is good, more is