Evaluating the Patient on Enteral Feeding

ASSESSMENT

INTERVENTION

EVALUATION/OUTCOME

Once the decision is made to tube feed, have a gastrointestinal work-up done to document intestinal motility, anatomic integrity, and presence/absence of gastroesophageal reflux.

Determine most appropriate feeding route:

Site of delivery (i.e., gastric, duodenal, or jejunal)

Tube placement (i.e., nasal or surgical)

Caregiver(s) and all involved medical professionals contribute to decisions regarding feeding route.

Have a medical/surgical assessment done.

Determine requirements for the following:

• Fluid
• Calories
• Protein
• Vitamins
• Minerals
• Electrolytes

Patient is receiving a nutritionally adequate feeding.

Before starting tube feeding, do a complete nutrition assessment, including the following areas: Please see section on Nutrition Assessment.

• Anthropometric
• Biochemical
• Physical
• Dietary

Determine most appropriate type of formula or breast milk and supplements.

Determine most appropriate method of formula delivery (i.e., bolus, continuous drip, or combination.)

Establish regular plan to increase volume with growth to maintain adequate nutrient intake (for young infants intake should be increased weekly)

Instruct caregiver(s) about the following:

• Obtaining the formula or breast milk and supplements
• Preparing the feeding
• Giving bolus feedings and using the pump
• Daily skin/stoma care
• When to call the doctor

Caregiver(s) obtain appropriate formula and supplements

Caregiver(s) demonstrate appropriate techniques for feeding. and stoma/skin care

Caregiver(s) know when to call MD

Once tube feeding has begun, monitor tolerance to tube feeding closely:

Maintain frequent contact with family by phone or clinic visits. Check for vomiting, diarrhea, constipation, and other adverse reactions. See section on Complications in Technical Aspects of Enteral Feeding.

As necessary make changes in:

• Type of feeding
• Amount of formula
• Method of delivery
• Additional supplements

Child tolerates feeding regimen and formula well. (No gastrointestinal disturbances or other signs of formula intolerance.)

Growth and indicators of fat and muscle stores, every 1 - 2 months until weight gain has been stable for 2 months.

Once child achieves appropriate weight for height (or length), evaluate need for reducing caloric intake to compensate for low energy needs due to immobility or paralysis.

Weight gain is stable and adequate.

Once weight gain has been stable for 2 months, reevaluate every 6 months (more often in periods of rapid growth, such as infancy and adolescence):

• Growth and indicators of fat and muscle stores.
• Nutrient adequacy of formula.
• Method of formula delivery
• Tolerance to formula.

Make changes in formula and delivery method as indicated by nutritional status.

Weight is appropriate for height (or length).

Formula meets requirements for calories, protein, vitamins, minerals, and electrolytes.

Fluid intake is adequate.