Please write a 750 word evidence-based response to each of the questions listed below.

Please write a 750 word evidence-based response to each of the questions listed below. Provide a rationale to support your response:

1. Describe enteral tube feeding and indications for use.

2. Identify two potential client problems associated with receiving enteral tube feedings.

3. Identify potential complications of enteral nutrition and discuss the related pathophysiology.

4. Discuss three priority nursing interventions that should be performed to manage each complication identified above."

1. Explain what is Enteral Tube Feeding and when it is indicated to be used:

 Enteral Tube Feeding Overview:

 Enteral feeding is a feeding process in which nutrients are introduced into the gastrointestinal tract via a tube which is passed into the stomach or the small intestine. This method is used where a patient is unable to take adequate nutrients through the mouth but has a normal gastrointestinal tract.

 Types of Enteral Tubes:

 Nasogastric Tube (NG Tube): It is passed through the nose and reach to the stomach. Commonly used in short term feeding, where feeding is done for a period of not more than 4-6 weeks.

 Ostomy Tubes: For instance PEG tubes, which is percutaneous endoscopic gastrostomy, or PEJ tubes, which is percutaneous endoscopic jejunostomy. These are passed into the stomach or jejunum through a small incision and are used for long term nutrition support.

 Indications for Enteral Tube Feeding:Indications for Enteral Tube Feeding:

 Inability to Swallow (Dysphagia): Some of the conditions that could hinder swallowing include stroke, neurological disorders or head and neck cancers.

 Critical Illness or Surgery: This is used in patients who are experiencing some forms of surgery or those with severe diseases and cannot take food but require a diet for them to recover.

 Chronic Illnesses: Severe anorexia, COPD, IBD, or any other condition in which oral nutrition is inadequate.

 Malabsorption Disorders: Various conditions, for example, Crohns disease that affects the nutrient’s absorption, require enteral feeding to enhance the nutrient uptake.

 Rationale: It is indicated for use in patients to provide nutrients by mouth when the patient is unable to take food orally. This method has an advantage over parenteral nutrition because it passes through natural route of the gastrointestinal tract and is less invasive.

 References:

 Boullata and Carney in their article published in Nutritional Clinics published in 2016. Enteral Nutrition in Adults: An Analysis of the Current Literature and Practice. Vol 31, No 3, 2016, pp 283-292: Nutrition in Clinical Practice.

 This service is provided by the National Institute for Health and Care Excellence (NICE). (2022). Nutritional Support for Adults. Retrieved from NICE. org. uk

 2. Two Possible Client Issues Concerning the Receipt of Enteral Tube Feedings:

 Problem 1: Aspiration Pneumonia

 Rationale: Aspiration pneumonia is a condition in which feeding formula through the enteral route gets into the lungs, usually because of incorrect placement of the tube or regurgitation. These include the patient with reduced level of consciousness, the patient with an impaired gag reflex or the patient receiving feedings at high rates. Aspiration can cause the inflammation as well as the infection of the lungs.

 Problem 2: Diarrhea

 Rationale: Diarrhoea is a complication that is frequently observed in patients on enteral feeding, and is usually attributed to the rate at which the feeds are given, the osmolality of the feeds used, or intolerance to certain types of feeds. Diarrhea has side effects such as dehydration and altered electrolyte levels.

 References:

 Rhoads, J. E. & Nair, S. C. (2015) Enteral Nutrition: Some of the Complications and How They are Handled. Gastroenterology Nursing, 38(6), 423-431.

 Heyland D. K. , Dhaliwal, R. , Avenell, A. , 2019. Nutritional Support in Critically Ill Patients: In this paper, the facts and controversies of the subject will be laid down. Published in Critical Care Medicine, volume 47, issue 6, the authors present the following findings: e295- e303.

 3. Describe the Possible Consequences of Enteral Nutrition and Explain the Pathophysiology of the Latter

 First complication: Gastrointestinal (GI) Complications

 Pathophysiology: Some of the GI complications include of nausea, vomiting, and abdominal cramping which may be as a result of the high feeding rates, formula intolerance or feeding through an improperly functioning GI tract. These symptoms are a consequence of stomach or intestines being unable to handle the load or type of feeding formula.

 Complication 2: Tube-Related Issues

 Pathophysiology: Possible complications include; displacement of the tube, blockage, or even infections at the site of insertion. Displacement may happen in case of improper fixation of the tube or if the patient removes it on his or her own. It is caused by blockage of the tube by formula or medication. It can develop from poor hygiene or from contamination at the time of tube placement.

 References:

 Moore, F. A & Moore, E. E (2016). Enteral Nutrition: Things to Remember for Clinicians. Peer-reviewed, Journal of Parenteral and Enteral Nutrition, 40(3), 351-357.

 Klek S. , & Olszewski R. (2020). Complications of Enteral Nutrition. Current Opinion in Clinical Nutrition and Metabolic Care; Vol. 23, No. 3; 225-231.

 4. Explain Three High Prioirty Nursing Interventions to Prevent/Manage Each of the Complication Mentioned Above

 For GI Complications:

 Monitor and Adjust Feeding Rates:Monitor and Adjust Feeding Rates:

 Rationale: Reduce the rate of feeding or change the osmolality of the formula if the patient complaints of gastrointestinal discomfort or diarrhoea. The symptoms should therefore be monitored on a regular basis and the feeding rate should be modified so as to minimize further complications.

 Administer Antiemetics:

 Rationale: In case of nausea or vomiting, the prescribed antiemetics can be given to the patient to manage this side effect and make the patient comfortable and more tolerant to the enteral feeding.

 Assess and Manage Fluid and Electrolyte Imbalances:Assess and Manage Fluid and Electrolyte Imbalances:

 Rationale: Solutions of this system are messy and can result in diarrhoea, which can cause dehydration and electrolyte imbalances. Assess and maintain Fluid balance, electrolytes and provide necessary replacement’s as per the case.

 For Tube-Related Issues:

 Ensure Proper Tube Placement and Securement:Ensure Proper Tube Placement and Securement:

 Rationale: Ensure timeously that the tube is in the correct position by using the right tools (e. g. X-ray, pH testing) and ensure that the tube is well secured with no risk of displacement. This prevent complications like aspiration or failure to meet the patient nutritional requirements as may be required.

 Routine Tube Flushing and Maintenance:Routine Tube Flushing and Maintenance:

 Rationale: To avoid blockage it may be helpful to flush the tube with water before and after feedings. To prevent blockage or infection, frequent cleaning and check up on the condition of the tube are advised to be done.

 Implement Infection Control Measures:

 Rationale: Ensure that there is proper cleansing of both the patient and the tube before it is inserted and also ensure proper sterilization of the tube and its accessories, also check for any signs of infection around the insertion site. This way, any signs of infection can be treated in good time to stop the occurrence of complications and to keep the tube working properly.

 References:

 S. A. McClave and B. E. Taylor (2016). The ESPEN Guidelines on Enteral Nutrition: Pathophysiology and Indications of the Nutritional Support in Adult Critically Ill Patients. Journal of Parenteral and Enteral Nutrition Volume 40, Number 2, pp. 159–211.

 Arabi, Y. M. , & Aldawood,, A. S. (2018) Enteral Nutrition Support in the Critically Ill Patient. Saudi Journal of Gastroenterology, 24(2) 67-77.