TOTAL NUTRITIONAL SUPPORT: PARENTERAL/ENTERAL FEEDING
Nutritional status is a key factor in patient’s overall immune function and a patient’s ability to mount a stress response.
Underfeeding a patient may lead to increased nosocomial infections, poor wound healing, respiratory muscle
dysfunction, and respiratory failure. Overfeeding patients, in contrast, may increase physiological stress and lead to
problems such as hyperglycemia, fluid overload, azotemia, and hepatic dysfunction. Therefore, measuring energy
expenditure and determining the patient’s caloric requirements and feeding status should be included in a thorough
nutritional assessment. Specifically designed nutritional therapy can be administered by the parenteral or enteral route
when the use of standard diets via the oral route is inadequate or not possible or enteral route when the use of standard
diets via the oral route is inadequate or not possible to prevent/correct protein-calorie malnutrition.
Enteral nutrition is preferred for the patient who has a functional GI tract but is unable to consume an adequate
nutritional intake or for whom oral intake is contraindicated/impossible. Feeding may be done via NG or orogastric
tube, esophagostomy, gastrostomy, duodenostomy, or jejunostomy.
Parenteral nutrition may be chosen because of altered metabolic states or when mechanical or functional
abnormalities of the GI tract prevent enteral feeding. Amino acids, fat, carbohydrates, trace elements, vitamins, and
electrolytes may be infused via a central or peripheral vein.
May be any setting, including community/home care
Burns: thermal/chemical/electrical (acute and convalescent phases)
Fluid and electrolyte imbalances
Inflammatory bowel disease
Psychosocial aspects of care
Renal failure: chronic
Patient Assessment Database
Clinical signs listed here depend on the degree and duration of malnutrition and include observations indicative of
vitamin, mineral, and protein/calorie deficiencies.
Muscle wasting (temporal, intercostal, gastrocnemius, dorsum of hand); thin extremities,
flaccid muscles, decreased activity tolerance
Diarrhea or constipation; flatulence associated with food intake
Abdominal distension/increased girth, ascites; tenderness on palpation
Stools may be loose, hard-formed, fatty, or clay-colored
Recent weight loss/weight loss of 10% or more of body weight within previous 6 mo
Problems with chewing, swallowing, choking, or saliva production
Changes in the taste of food; anorexia, nausea/vomiting; inadequate oral intake (NPO)
status for 7–10 days, long-term use of 5% dextrose intravenously
Actual weight (measured) as compared with usual or pre-illness weight is less than 90% of