Which two patients should the nurse expect will need enteral nutrition?

October 14, 2025 •

4 min read

According to the American College of Gastroenterology, enteral nutrition is preferred over parenteral nutrition when the gastrointestinal tract is functioning. The core principle of determining the need for a feeding tube relies on a simple assessment: can the patient ingest enough nutrients orally, safely? A nurse should expect that patients who cannot swallow or are unable to consume adequate calories due to specific medical conditions will require enteral nutrition.

Quick Summary

This article discusses the clinical criteria for initiating enteral nutrition, explaining how a nurse can identify specific patient conditions necessitating tube feeding, such as swallowing impairment or critical illness. It details the common medical scenarios that require this form of nutritional support and explores key considerations for nursing assessment.

Key Points

Dysphagia from Stroke: A key indicator for enteral nutrition is a neurological impairment, often caused by a stroke, that compromises the ability to swallow safely, leading to a high risk of aspiration.
Head and Neck Cancer: Patients with head and neck cancer, or those undergoing its treatment, frequently require enteral feeding due to physical obstructions or painful side effects that inhibit oral intake.
Functional GI Tract: A prerequisite for enteral nutrition is a functioning gastrointestinal tract, as it uses the body's own digestive processes for nutrient absorption.
Prevention of Complications: Enteral nutrition helps prevent common complications of malnutrition, such as poor wound healing and infections, by providing consistent and adequate nutritional intake.
Comprehensive Nursing Care: The nurse's role includes monitoring for complications, verifying tube placement, and educating patients and families, which is critical for the success of enteral feeding.
Risk for Aspiration: A patient's inability to protect their airway is a significant factor driving the need for enteral tube feeding to prevent aspiration pneumonia.

Understanding the Need for Enteral Nutrition in Patient Care

Enteral nutrition involves delivering nutrients directly into the gastrointestinal (GI) tract via a tube, providing a vital lifeline for patients who cannot eat by mouth but have a functional digestive system. A nurse's clinical judgment is crucial for identifying patients who will benefit from this nutritional intervention, which is safer, less expensive, and helps preserve gut integrity compared to intravenous (parenteral) feeding. While many conditions can lead to the need for tube feeding, two clear-cut examples frequently encountered in a clinical setting involve severe swallowing impairment and head/neck-related trauma or cancer.

Patient 1: The Stroke Survivor with Dysphagia

One of the most common reasons a patient requires enteral nutrition is dysphagia, or difficulty swallowing, which is frequently caused by a cerebrovascular accident (stroke). A stroke can damage the neural pathways controlling the muscles and reflexes necessary for safe swallowing. The inability to properly swallow can lead to aspiration—where food or liquids enter the lungs—which can cause aspiration pneumonia, a serious and life-threatening infection.

A nurse's assessment of a post-stroke patient might reveal several indicators for enteral feeding:

Visible Difficulty: Coughing or choking during mealtime, a gurgling sound in the voice, and a wet-sounding cough after swallowing are all red flags for dysphagia.
Impaired Consciousness: Some stroke patients may have a decreased or altered level of consciousness, making it impossible to safely consume food orally.
Malnutrition: Over time, a patient's caloric intake will drop significantly, leading to unintentional weight loss, muscle wasting, and overall malnutrition, which impairs recovery.

The nursing evaluation focuses on confirming the patient's neurological deficit and its effect on their ability to eat. An inability to protect their airway makes oral intake extremely hazardous, making enteral nutrition an immediate and necessary intervention.

Patient 2: The Head and Neck Cancer Patient

Another patient who should be expected to require enteral nutrition is one with advanced head or neck cancer. The tumor itself may cause an obstruction of the pharynx or esophagus, physically blocking the passage of food. Even when not directly obstructed, the cancer or its treatments, such as radiation therapy to the head and neck, can cause painful mucositis (inflammation of the mucous membranes), severely impacting the ability to chew and swallow.

For these patients, the nursing assessment will likely highlight:

Physical Obstruction: The patient reports a feeling of food getting stuck or is unable to swallow solid food.
Treatment Side Effects: The side effects of chemotherapy and radiation, including severe nausea, fatigue, and pain, can drastically reduce appetite and oral intake.
Pre-emptive Placement: In many cases, a feeding tube, such as a percutaneous endoscopic gastrostomy (PEG), may be placed proactively before beginning cancer treatment to prevent future malnutrition and provide a stable route for nourishment.

For the head and neck cancer patient, enteral feeding is not only for nutrition but also to help maintain strength and prevent malnutrition during a metabolically taxing period of therapy.

Comparison of Enteral Nutrition Needs


Factor	Patient with Stroke-Induced Dysphagia	Patient with Head and Neck Cancer
Primary Cause	Neurological damage affecting the swallowing reflex.	Physical obstruction from the tumor or side effects from cancer treatment.
Likely Duration	Can be short-term or long-term, depending on recovery of swallowing function.	Often required long-term, especially if the treatment involves extensive radiation.
Associated Risk	High risk of aspiration pneumonia due to the inability to protect the airway.	Malnutrition and poor wound healing due to reduced oral intake during intense therapy.
Feeding Tube Type	Initially a temporary nasogastric tube; may transition to a gastrostomy tube for long-term use.	Often a long-term gastrostomy (PEG) or jejunostomy tube is placed proactively.
Nursing Priority	Aspiration prevention and regular swallowing assessments.	Aggressive nutritional support to maintain weight and strength during and after treatment.

Key Considerations for Nursing Practice

For both patient scenarios, the nurse's role extends beyond simply administering the feeding. It involves a holistic approach to care that addresses potential complications and promotes patient well-being. This includes monitoring for signs of intolerance (such as nausea, vomiting, or diarrhea), ensuring proper tube placement, and providing thorough patient and family education. Timely and appropriate nutritional support is critical for improving patient outcomes, reducing hospital stays, and supporting the body's healing processes.

Conclusion

In summary, a nurse should expect that a patient with severe dysphagia following a stroke and a patient undergoing treatment for head and neck cancer will both require enteral nutrition. Their underlying pathologies, impaired swallowing for the former and physical obstruction or treatment effects for the latter, prevent them from safely meeting their nutritional needs orally. By identifying these high-risk patients early and initiating enteral feeding, nurses play a vital role in preventing malnutrition, reducing complications like aspiration, and supporting the patient's overall recovery and quality of life. This fundamental nursing assessment and intervention directly addresses the patient's most basic need for sustenance when they are unable to provide it for themselves. An excellent resource for further clinical practice guidelines can be found on the American Society for Parenteral and Enteral Nutrition website.

Frequently Asked Questions

Enteral nutrition is preferred because it is more physiological, cheaper, and associated with fewer complications, particularly infections, as it helps preserve the structure and function of the gastrointestinal tract.

A nurse can assess for dysphagia by observing for signs like coughing, choking, or a gurgling voice during or after swallowing, and by checking for decreased or altered consciousness that may impair safe oral intake.

Side effects like severe nausea, fatigue, painful mucositis from radiation therapy, and physical obstruction from a tumor can all make it difficult for cancer patients to eat enough, necessitating enteral nutrition.

For long-term feeding, which is considered longer than four to six weeks, a gastrostomy (G-tube) or jejunostomy (J-tube) is typically placed. These tubes are inserted directly through the abdominal wall into the stomach or small intestine.

The main risk is aspiration, which is when food or liquids accidentally enter the lungs instead of the stomach. This can lead to serious respiratory infections, such as aspiration pneumonia.

Yes, medications can be administered through an enteral feeding tube. It is important to flush the tube with water before and after medication administration to prevent clogging and to ensure proper delivery.

Nurses should monitor for signs of intolerance like nausea, vomiting, or diarrhea, and check for any mechanical issues such as a clogged or dislodged tube. Weight and hydration status are also important indicators to monitor.