Fundamentals - Practice & Skills, part 21: Enteral and Parenteral Nutrition

by Meris Shuwarger August 11, 2021 Updated: August 15, 2021

Full Transcript

Hi, I'm Meris, and in this video, we're going to be talking about enteral and parenteral nutrition. I'll be following along using our fundamentals of nursing flashcards. These are available on our website levelrn.com. And if you already have a set, I'd invite you to follow along with me. I'm going to be starting on card number 111. Let's get started. So to start off, let's talk about enteral nutrition. So enteral has the same root word as "gastroenteritis," for instance, right? The word "entero" means referring to the GI tract. So when we're talking about enteral nutrition, this means nutrition that is delivered to the GI tract. So, yes, I'm not eating it in my mouth and swallowing and everything like that for myself, but my GI tract is still processing the nutrients. This is preferable when we have an option because this is going to allow us to keep that GI system functioning, keep gastric motility working, peristalsis working, all of that sort of stuff. So this is the preferred method of artificial nutrition. Now, let's talk about the different types. In the last video, we talked about NG tubes. NG tubes are really great if we need short-term feedings. But if we have a patient who is going to need enteral feeds for longer than four weeks, we really should consider a percutaneous, meaning through the skin-- percutaneous tube. So this could be a peg tube, a G tube, a GJ tube. Any of these things you might hear, the reason being NG tubes are going to be very irritating to the nose and the esophagus over time and can even cause different types of pressure injuries.

All right. So moving on, we're going to talk about kind of some best practices for enteral nutrition. So you'll see here on cards 112 and 113, we've got a whole bunch of information, a lot of bold red information, a lot of bullet points as well. So I'm not going to take you through every single one, but I am going to point out some highlights. So first thing is we always want to make sure that when we are administering a feed to a patient, we want the head of the bed to be elevated to 30 to 45 degrees. I'm going to ask you a question, and after I ask it, pause the video, think about the answer, and then click play. Why do we want to have the head of the bed elevated between 30 and 45 degrees? Go ahead and pause. All right. I hope you paused. The answer is because it decreases aspiration risk. Imagine that you are drinking a glass of water while laying flat. You are at high risk for aspiration. Same thing if I'm putting nutrients into your stomach and you're laying flat. We need to sit you up. Big, big, important concept there. Other things is that we need to make sure to aspirate the gastric contents before we start a feed. So every facility, policy, and textbook is going to be a little bit different. But the thing here to know is before a feed, I need to use a syringe, a large syringe, to aspirate, to pull out whatever is left in the stomach. This allows me to measure how much is left in the stomach when it's time for the next feed. This may mean that we need to change the frequency of the feeds, or it might speak to a GI problem. So you're going to want to follow your facility policies, of course. But in general, if it is larger than 500 mls, we're not going to return it to the stomach. We're going to call the provider. But anything under 500 milliliters, we are going to return to the stomach. On the next card here, there's one big thing in bold red, which is that we flush the tube with 30 milliliters of water before and after every feeding with medications, gastric residual volume checks, or, if we have a continuous feed going on, we're going to flush that tube with 30 mls every four hours. Got to change the tubing and delivery sets every 24 hours to prevent microbial growth. And we want to make sure that open cans of formula should be refrigerated and discard them after 24 hours, very important to know so that we can maintain infection control.

All right. Lastly, let's talk about parenteral nutrition. So enteral means the GI tract. So why is that word "parenteral"? Because the word "para" means around. So it's going around the GI tract. It's circumventing or avoiding the GI tract. If you really like knowing what these things mean, I would very much encourage you to check out our medical terminology deck so you can be more familiar with what these roots mean. So "parenteral" means around the GI tract, avoiding it. So this is going to be delivered into the vascular space, i.e., the bloodstream directly, so important stuff. Look, we got a lot of bold and red information here because you've got to know it. Important stuff to know here is that we have to use some sort of a central line for this; we can't be using a peripheral IV. So we need either a PICC line or a central venous catheter-- central line. Huge, huge, huge thing to know here is that because we are giving someone artificial nutrition, we need to be checking their glucose levels. Are they getting enough? Are they getting too much? I'm going to ask you a question. I want you to pause. We have to make sure that whatever is hanging, whatever TPN, total parenteral nutrition, is hanging, is discarded after 24 hours. Why? Go ahead and pause. I hope you paused. The answer is to prevent microbial growth. Bacteria love sugar, and TPN has a lot of glucose in it, so bacteria are very likely to grow there. So I would definitely know that for all of your nursing school exams, [inflects?], and clinical practice. If for some reason the next bag of TPN were unavailable, we would still want to discontinue it after 24 hours, but we need to hang something that has glucose. So here on the card, we say you would want to administer 10 to 20 percent dextrose in water until the next bag is available. And of course, that's going to be per-order and per-facility policy. I hope that review was helpful. If that was, please like this video; it would mean so much to me. And if you have any great tips or tricks or ways to remember things, I'd love to hear them in the comments. And so with the other people watching, I hope you've subscribed to the channel because you want to be the first to know when a new video drops. And the next video in this series is going to be talking about urinary specimen collection, incontinence, and urinary tract infections, really important stuff. All right, thanks so much, and happy studying.


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