Med-Surg · chapter 19 · Gastrointestinal System and Disorders
Parenteral and Enteral Nutrition
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.
Key points
Parenteral nutrition contents
The term parenteral nutrition refers to a concentrated solution containing glucose, amino acids, minerals, electrolytes, and vitamins that is administered to a patient intravenously.
Central catheter rationale
Parenteral nutrition is administered via a large central IV catheter (also known as a “line”), typically in the subclavian or internal jugular vein, because the high dextrose concentration is irritating to small blood vessels and can cause chemical phlebitis.
Parenteral nutrition indications
Parenteral nutrition is typically used when the patient’s intestines or stomach are not working properly and must be bypassed, such as during paralytic ileus, in which peristalsis has completely stopped, or after postoperative bowel surgeries, such as bowel resection.
TPN rate safety
TPN rates should be strictly followed. If administered too fast, the patient can go into fluid overload (hypervolemia) and become hyperglycemic; if administered too slowly, the patient can become hypoglycemic.
Central line verification
The central line is inserted by the provider, then a chest x-ray is ordered and read prior to using the site. The chest x-ray ensures proper placement of the line and that placement did not cause a pneumothorax, or collapsed lung.
Peripheral line infiltration
If the peripheral line infiltrates, the line must be restarted promptly. A delay in restarting the IV line is a safety concern because it places the patient at risk for hypoglycemia.
Infection prevention measures
These measures include hand hygiene, prevention of needle or syringe contamination, preparation of the access site, prevention of contamination of the solution, and use of new, sterile tubing for each bag of nutrition.
Enteral nutrition route
Nutrition provided directly into the GI tract through an enteral tube that bypasses the oral cavity is called enteral nutrition (EN), or tube feeding.
Tube feeding prescription review
Prescriptions for EN should be reviewed by the nurse for the following components: type of EN formula, amount and frequency of free water flushes, and administration route, method, and rate.
Enteral feeding indication
Enteral feeding is indicated for patients who cannot maintain adequate oral intake to meet nutritional demands.
NG tube functions
An NG tube is a single- or double-lumen tube that is inserted into the nasopharynx, then down through the esophagus, and into the stomach. NG tubes can be used for feeding, medication administration, and suctioning.
Aspiration pneumonia risk
The most serious complication of enteral feeding is inadvertent respiratory aspiration of gastric contents, which can cause life-threatening aspiration pneumonia.
Aspiration prevention positioning
Maintain the head of the bed at 30° to 45° unless contraindicated.
Feeding tube clogging
Feeding tubes are prone to clogging for a variety of reasons, including size or location of the tube, insufficient water flushes, aspiration for gastric residual volume (GRV; the volume of stomach contents), contaminated formula, and incorrect medication preparation and administration.
Terms to know
- parenteral nutrition
- The term parenteral nutrition refers to a concentrated solution containing glucose, amino acids, minerals, electrolytes, and vitamins that is administered to a patient intravenously.
- total parental nutrition (TPN)
- Parenteral nutrition that includes an intravenous fat emulsion (IV administration of fat) provides complete nutritional support and so is called total parental nutrition (TPN).
- peripheral parenteral nutrition
- Peripheral TPN, also called peripheral parenteral nutrition, is typically used for shorter-term nutritional support or for a patient who cannot tolerate a central line.
- enteral nutrition (EN)
- Nutrition provided directly into the GI tract through an enteral tube that bypasses the oral cavity is called enteral nutrition (EN), or tube feeding.
- NG tube
- An NG tube is a single- or double-lumen tube that is inserted into the nasopharynx, then down through the esophagus, and into the stomach.
- PEG tube
- A PEG tube is placed into the stomach via an endoscopic procedure.
- PEJ tube
- Alternatively, a PEJ tube is placed in the jejunum of the small intestine for patients who cannot tolerate the administration of enteral formula or medications into the stomach, due to medical conditions such as delayed gastric emptying.
- pneumothorax
- The chest x-ray ensures proper placement of the line and that placement did not cause a pneumothorax, or collapsed lung.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
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Every question here, with the answer
At the 1200 assessment, the centimeter mark on a patient's NG tube reads 55 cm at the nare, matching the documented 0800 reading. Which entry best documents this external-position assessment?
- 1200: NG tube external length unchanged from 0800.
- 1200: NG tube mark at nare 55 cm, unchanged from 0800.
- 1200: NG tube centimeter mark verified against previous documentation.
- 1200: NG tube assessed; no change in external position noted.
Answer: 1200: NG tube mark at nare 55 cm, unchanged from 0800.
The section specifically requires documenting and verifying the centimeter mark at each assessment. The other entries describe an assessment or an unchanged position but omit the actual centimeter mark.
At 0800, an EN prescription replaces yesterday's prescription. It specifies a new formula and the same route and administration method, but omits the feeding rate and free water flush instructions. Before administering feeding, which entries appropriately document your prescription review and planned follow-up? Select all that apply.
- Missing prescription components referred to the dietitian for authorization rather than to the provider.
- Feeding rate unspecified; verify with provider before administering tube feeding.
- Yesterday's feeding rate carried forward because the route and administration method are unchanged.
- Free water flush amount and frequency unspecified; verify with provider before administering tube feeding.
- Yesterday's flush amount and frequency carried forward because the new prescription does not specify changes.
Answer: Feeding rate unspecified; verify with provider before administering tube feeding., Free water flush amount and frequency unspecified; verify with provider before administering tube feeding.
The nurse should review the feeding rate and the amount and frequency of free water flushes, verifying concerns with the provider before feeding. Carrying forward previous instructions substitutes an assumption for verification. The dietitian assesses nutritional needs, but the section assigns prescribing and clarification of prescription concerns to the provider.
At 0930, a provider has inserted a central line for TPN. The chest x-ray has been obtained but has not yet been read, and the prescribed TPN is ready. Which entry best documents the appropriate administration status and plan?
- 0930: Chest x-ray interpretation pending; TPN not started. Await confirmation of line position and absence of pneumothorax.
- 0930: Chest x-ray interpretation pending; TPN started at a reduced rate until placement is confirmed.
- 0930: Central line insertion completed by provider; TPN started, with chest x-ray review to follow.
- 0930: Chest x-ray obtained; TPN started at the prescribed rate while interpretation is pending.
Answer: 0930: Chest x-ray interpretation pending; TPN not started. Await confirmation of line position and absence of pneumothorax.
The section requires the chest x-ray to be read before the central line is used, confirming position and absence of pneumothorax. Obtaining the image or completing line insertion does not satisfy that requirement. Starting at a reduced rate also bypasses the required confirmation and conflicts with following the prescribed TPN rate strictly.
Where every quote comes from
Section 19.3 Parenteral and Enteral Nutrition of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.