What are the signs that a patient is not tolerating enteral feedings quizlet?

Over one-third of mechanically ventilated patients experience enteral feeding intolerance, according to some studies. Recognizing the signs that a patient is not tolerating enteral feedings quizlet can help healthcare providers and caregivers intervene promptly, ensuring the patient's safety and nutritional needs are met.

Quick Summary

This guide outlines the gastrointestinal, systemic, and mechanical indicators of enteral feeding intolerance, detailing key signs such as abdominal pain, vomiting, and high gastric residuals for comprehensive patient monitoring.

Key Points

• Gastrointestinal Symptoms: Common signs of intolerance include abdominal distension, cramping, nausea, vomiting, diarrhea, and constipation.

• High Gastric Residuals: While controversial, a high GRV (over 500 mL) can indicate delayed gastric emptying, especially when accompanied by other GI symptoms.

• Systemic Indicators: Look for signs like unexplained weight loss, dehydration, electrolyte imbalances, or hyperglycemia.

• Assessment is Key: Nurses must perform regular assessments, including abdominal palpation and monitoring stool output, to identify feeding intolerance early.

• Causes of Intolerance: Factors contributing to intolerance include feeding rate, formula type, medications, underlying illness, and improper tube placement.

• Management Strategies: Interventions like slowing the feeding rate, proper patient positioning, and team consultation are vital for managing intolerance.

• Preventing Aspiration: Keeping the patient's head elevated to 30-45 degrees during and after feeding is essential to minimize the risk of aspiration.

Recognizing Gastrointestinal Signs

Recognizing gastrointestinal (GI) signs is the first and most critical step in identifying feeding intolerance. These symptoms directly reflect the body's reaction to the formula and its inability to digest or absorb it properly.

Abdominal Discomfort and Distension

Abdominal discomfort is a primary sign of feeding intolerance, often manifested as cramping or a bloated, full feeling. Abdominal distension, or a visibly swollen abdomen, is a classic physical finding that suggests the stomach is not emptying properly. This can be caused by delayed gastric motility, gas accumulation, or an excessive volume of formula being administered too quickly. In severe cases, pain can accompany the distension, alerting staff to a potentially serious issue.

Nausea and Vomiting

Nausea and vomiting are among the most common and obvious signs that a patient is not tolerating enteral feedings. Nausea may manifest as patient complaints or restlessness, while vomiting, especially large-volume emesis, is a clear indicator that the stomach is rejecting the formula. This poses a significant aspiration risk, a life-threatening complication where formula enters the lungs. In patients who cannot verbally communicate, such as those on mechanical ventilation, observation for physical signs of nausea is essential.

Altered Bowel Function

Both diarrhea and constipation can signal enteral feeding intolerance. Diarrhea, defined as passing three or more liquid stools per day, can be caused by rapid feeding rates, a formula that is poorly tolerated, or infection. Conversely, constipation can result from inadequate fiber in the formula, dehydration, or slowed gastrointestinal motility. Both conditions interfere with nutrient absorption and require careful assessment.

High Gastric Residual Volume (GRV)

While the clinical significance of GRV has been debated, it remains a common practice in many settings, particularly for high-risk patients. It involves aspirating stomach contents to measure the volume of undigested formula. A persistently high GRV, often defined as a volume over 500 mL, may indicate delayed gastric emptying. However, guidelines from organizations like ASPEN suggest that GRV thresholds below 500 mL should not routinely prompt feeding cessation unless accompanied by other signs of intolerance, as this can interrupt essential nutrition.

Systemic and Other Indicators

Intolerance is not solely confined to the GI tract. Systemic signs can also provide crucial clues.

• Dehydration: Changes in skin turgor, dry mucous membranes, and decreased urinary output can signal dehydration, often a side effect of severe diarrhea.
• Electrolyte Imbalance: Feeding intolerance can disrupt electrolyte balance, especially in cases of refeeding syndrome or severe diarrhea. Monitoring electrolytes like potassium, magnesium, and phosphate is critical.
• Hyperglycemia: High blood sugar levels can be a sign of feeding intolerance, particularly in critically ill patients.
• Fever or Infection: A low-grade fever or other signs of infection can sometimes be related to bacterial overgrowth or formula contamination, which can cause intolerance.
• Weight Changes: Unexplained weight loss can be a sign of malabsorption or inadequate nutrient delivery due to intolerance.

Causes of Enteral Feeding Intolerance

Understanding the potential causes is key to effective management. These can range from easily correctable issues to more complex medical conditions.

1. Formula-Related Factors:

   • Rate of Administration: Feeding the formula too quickly is a frequent cause of intolerance.
   • Formula Type: The formula itself might not be suitable, with some patients intolerant to specific proteins or fiber content.
   • Temperature: Formulas that are too cold can sometimes cause cramping.

2. Patient-Related Factors:

   • Underlying Illness: Conditions like gastroparesis, intestinal obstruction, or sepsis can significantly affect gastric motility.
   • Medications: Many drugs, such as sedatives or narcotics, can slow GI motility. Liquid medications containing sorbitol can cause diarrhea.
   • Patient Positioning: Lying flat during or after feeding significantly increases the risk of reflux and aspiration.

3. Mechanical Complications:

   • Tube Migration: If the feeding tube moves from its intended position (e.g., from the jejunum to the stomach), it can cause intolerance.
   • Tube Blockage: A blocked tube can impede feeding and cause discomfort.

Comparison of Tolerated vs. Intolerated Feeding

Parameter	Tolerated Feeding	Intolerated Feeding
Abdominal Exam	Soft, non-distended, with active bowel sounds	Distended, firm, and often tender or painful
Nausea & Vomiting	Absent or mild, infrequent nausea	Frequent complaints of nausea, or active vomiting
Bowel Function	Regular, soft, and formed stools	Frequent liquid stools (diarrhea) or severe constipation
Gastric Residuals	Consistently low volumes (<500 mL)	High, often increasing, residual volumes (>500 mL)
Patient Comfort	Patient appears comfortable and calm	Patient is restless, complains of fullness, or appears distressed
Aspiration Risk	Low risk with proper positioning	High risk due to reflux and vomiting
Weight	Stable or increasing towards nutritional goals	Unexplained weight loss or plateau

Clinical Management of Feeding Intolerance

When signs of intolerance appear, immediate action is necessary. Key steps include:

• Assessment and Observation: Conduct a thorough assessment of the patient's symptoms, including abdominal exam, bowel function, and overall comfort.
• Feeding Adjustments: Often, simply slowing the infusion rate can resolve the issue. If the feeding is continuous, a temporary pause and gradual reintroduction might be needed.
• Repositioning: Ensure the patient's head is elevated to at least 30-45 degrees during and for 30-60 minutes after feeding to prevent reflux.
• Consultation: Collaborate with the healthcare team, including the provider, dietitian, and pharmacist. A change in formula type (e.g., lower fat, different fiber content) or addressing medication side effects may be necessary.
• Check Tube Placement: Reconfirming the tube's position is critical, especially if symptoms appear suddenly.

Conclusion

Identifying the signs that a patient is not tolerating enteral feedings is a crucial skill for all healthcare professionals involved in nutritional support. By conducting a thorough assessment of GI, systemic, and other indicators, and by understanding the potential causes, clinicians can provide timely and effective interventions. As highlighted by various Quizlet and clinical resources, recognizing symptoms like abdominal distension, vomiting, and diarrhea is paramount to ensuring patient comfort, minimizing complications, and achieving optimal nutritional outcomes. Close monitoring and collaborative management are essential for successful enteral nutrition.

For additional information on feeding intolerance and troubleshooting, refer to resources from organizations like Nestlé Health Science.

Frequently Asked Questions

What are the most common signs of enteral feeding intolerance?

The most common signs include gastrointestinal symptoms such as nausea, vomiting, abdominal cramping, diarrhea, and abdominal distension.

How is a high gastric residual volume (GRV) related to feeding intolerance?

A high GRV, typically defined as over 500 mL, can indicate delayed gastric emptying. However, modern guidelines often emphasize that GRV should be considered alongside other clinical signs rather than as a sole indicator of intolerance.

What nursing actions can help prevent aspiration due to feeding intolerance?

To prevent aspiration, nurses should maintain the patient's head of bed elevated to 30-45 degrees during feeding and for a period after, and monitor for signs like nausea and vomiting.

Can medications cause enteral feeding intolerance?

Yes, many medications can affect gastrointestinal motility and absorption. For example, some liquid medicines contain sorbitol, which can cause diarrhea. It's crucial to review a patient's medication list with a pharmacist.

What is the first step a nurse should take when a patient shows signs of intolerance?

The first step is to assess the patient thoroughly for symptoms and potential causes. Often, interventions like slowing the feeding rate or repositioning the patient can resolve the issue.

Why is abdominal distension a key indicator?

Abdominal distension suggests that the stomach is not emptying efficiently, leading to a buildup of fluid and gas. It is a clear physical sign of GI distress and poor motility.

Should feeding be stopped immediately if a patient has a high GRV?

Not necessarily. Current guidelines recommend against stopping enteral nutrition solely based on GRV, especially if the volume is less than 500 mL and other signs of intolerance are absent. Cessation should be reserved for significant volumes or other concerning symptoms.

What other conditions might mimic enteral feeding intolerance?

Underlying medical conditions like bowel obstruction, severe infection, or even psychological distress can present with symptoms similar to feeding intolerance. A comprehensive medical assessment is needed to differentiate these.