Which patient is most likely to be a candidate for total ...

[mspears3]

Which patient is most likely to be a candidate for total parenteral nutrition (TPN) rather than enteral nutrition?
 
  a. A patient who is comatose after having had a stroke
  b. A patient who has a fractured mandible following a motor vehicle accident
  c. A patient who has cerebral palsy and severe dysphagia
  d. A patient who is pregnant and has intractable hyperemesis gravidarum

Question 2

The nurse is preparing to administer an enteral feeding to a patient who receives 300 mL of Isocal over 30 minutes every 4 hours. The nurse checks the residual prior to initiating the feeding and notes a residual amount of 50 mL of formula.
 
  Which action will the nurse take next?
  a. Administer the feeding as ordered.
  b. Administer the feeding over 60 minutes.
  c. Hold the feeding and notify the patient's provider.
  d. Wait 1 hour and recheck the residual again.

[sarahccccc]

Answer to Question 1

ANS: D
The patient who is vomiting will be unable to tolerate enteral nutrition. Enteral feedings require a functioning gastrointestinal tract. TPN is more costly and does not carry significant benefits when compared with risks, so it should only be used when enteral nutrition cannot be used.

Answer to Question 2

ANS: A
The nurse should determine gastric residual before each feeding when patients are receiving intermittent feedings. A residual greater than 50 of a previous feeding indicates delayed gastric emptying and warrants notifying the provider. This patient has a residual less than 50, so the nurse may proceed with the next feeding. A residual of 50 mL is significant in patients receiving continuous enteral feedings. The nurse cannot change the rate of an enteral infusion without an order from the provider.

[mspears3]

Excellent

[softEldritch]

TYSM