Question

A patient is receiving both parenteral (PN) and enteral nutrition (EN). When would the nurse collaborate with the health care provider and request a discontinuation of parenteral nutrition? a. When \(25 \%\) of the patient's nutritional needs are met by the tube feedings b. When bowel sounds return c. When the central line has been in for 10 days d. When \(75 \%\) of the patient's nutritional needs are met by the tube feedings

Short answer

The nurse should collaborate with the health care provider to request a discontinuation of parenteral nutrition when 75% of the patient’s nutritional needs are met by the tube feedings.

Step-by-step solution

Understanding the Components of Nutrition

Parenteral nutrition (PN) is delivered intravenously, bypassing the digestive system. Enteral nutrition (EN) involves tube feedings that use the gastrointestinal (GI) tract. The decision to switch from PN to EN depends on the patient's ability to tolerate and meet nutritional needs through the GI tract.

Identifying the Correct Criterion for Discontinuation

The appropriate time to discontinue PN in favor of EN alone is when a significant portion of the patient’s nutritional needs are being met through enteral feedings. Discontinuing PN too early can lead to inadequate nutrition, while discontinuing it too late can increase the risk of complications from prolonged use of a central line.

Evaluating the Answer Choices

Option (a) suggests discontinuing PN when 25% of the nutritional needs are met by EN, which is too low. Option (b) is not directly related to meeting nutritional needs. Option (c) is related to the duration of central line use, not nutritional status. Option (d) is plausible because it indicates a substantial portion of nutritional needs (75%) is met by EN, implying the GI tract can likely handle the full nutritional requirement.

Key concepts

Parenteral Nutrition (PN)

Parenteral nutrition (PN), a form of medical feeding method, is a lifesaver for patients who cannot consume or absorb nutrients through their gastrointestinal tract. PN is administered intravenously, supplying all the nutrients the body needs, such as carbohydrates, proteins, fats, vitamins, and minerals, directly into the bloodstream.

When managing PN, it's essential for health professionals to understand the complexities involved, including the correct balance of nutrients, preventing infections associated with intravenous feeding, and the timing for discontinuation. Ideally, PN is tapered off when the patient is able to meet their nutritional needs through oral intake or enteral nutrition, indicating that the gastrointestinal system is functioning sufficiently.

Enteral Nutrition (EN)

Enteral nutrition (EN) involves feeding patients through a tube directly into the stomach or small intestine. EN is the preferred method of providing medical nutrition therapy when the digestive system is working but the patient is unable to eat by mouth due to factors such as lack of appetite, an obstruction, or impaired swallowing.

Unlike PN, enteral feeding uses the natural digestive process, which is beneficial for gut integrity and can lead to fewer infections compared to PN. Nurses play a crucial role in monitoring patients on EN, ensuring they are tolerating the feedings well and that their nutritional needs are being adequately met before considering the discontinuation of PN.

Nutrition in Nursing

Nutrition plays a pivotal role in nursing care altogether. Nurses must have a strong grasp of nutritional science to accurately assess a patient's nutritional status and needs. They oversee the administration of both PN and EN, monitor the patient's response to the nutrition therapy, and collaborate with dietitians and physicians in the management of the patient's overall nutrition plan.

In the transition from parenteral to enteral nutrition or oral intake, nurses must carefully watch for any signs of intolerance, such as nausea, vomiting, or diarrhea, and be vigilant in the prevention of complications such as aspiration pneumonia or tube displacement.

Gastrointestinal Tract Nutrition

The gastrointestinal (GI) tract is designed to break down food and absorb nutrients, making it the most natural route for nutrition. Maintaining GI tract function through enteral nutrition can support immunity and reduce the risk of infection.

Whenever possible, using the GI tract for nutrition is preferred over PN because it maintains gut integrity and function. The transition from PN to EN typically occurs once the GI tract is deemed functional and can handle the nutritional load. This is often determined when a substantial percentage of a patient's nutritional goals—commonly around 75%—can be met via tube feedings, minimizing the risks of PN and making full use of the GI tract's capacities.