Which feeding therapy is used in a critically ill client admitted to the Intensive Care Unit (ICU)?

SGPGI Nursing Officer-2022

Medical & Surgical Nursing

Easy

Appeared in: SGPGI Nursing Officer-2022

Explanation

Enteral nutrition is the preferred, first-line feeding method for critically ill patients with a functional gastrointestinal (GI) tract.
This approach follows the principle "if the gut works, use it," which is standard practice in critical care.
Using the gut preserves its mucosal integrity, maintains immune function, and reduces the risk of infection compared to intravenous feeding.
Enteral nutrition is also more cost-effective and associated with fewer severe metabolic complications than parenteral nutrition.

Option B: Parenteral nutrition bypasses the gastrointestinal tract and is only used when the gut is non-functional (e.g., due to obstruction or ileus). It carries higher risks of infection, gut atrophy, and metabolic complications.
Option C: DNS (Dextrose Normal Saline) with insulin is an intravenous fluid used for hydration and managing blood sugar. It is not a complete nutritional formula as it lacks protein, fats, and essential micronutrients.
Option D: Similar to the option with insulin, DNS with multivitamins provides hydration and some vitamins but is nutritionally incomplete. It cannot meet the high caloric and protein needs of a patient in the ICU.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Nutritional support for critically ill patients in acute care settings.
Nurses play a critical role in managing enteral feeding, including ensuring correct tube placement, preventing aspiration by elevating the head of the bed, monitoring for tolerance, and maintaining tube patency.
Advocating for the initiation of early enteral nutrition (within 24-48 hours of admission) is a key nursing responsibility that can improve patient outcomes.
What if? If the critically ill patient develops a paralytic ileus (absent bowel sounds, abdominal distension), enteral feeding would be held or stopped. The correct action would be to notify the physician and anticipate a switch to parenteral nutrition until gut function returns.

How to Approach the Question

First, identify the keywords in the question: 'critically ill client,' 'ICU,' and 'feeding therapy.' This points to a question about advanced nutritional support.
Recall the fundamental principle of nutrition in critical care: 'If the gut works, use it.' This is a crucial decision-making rule.
Evaluate the options based on this principle. 'Enteral' means using the gastrointestinal tract.
'Parenteral' means bypassing the gut and using an IV route.
Recognize that DNS solutions are primarily for hydration and electrolyte balance, not complete nutrition.
Based on the principle, conclude that enteral feeding is the preferred, first-line method whenever possible.

Concept Tested & Keywords

Concept Tested: Nutritional support for critically ill patients
Stem keywords: feeding therapy, critically ill, Intensive Care Unit, ICU
Lead-in keywords: Which
Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.

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E6 Nutrition Kumud Khanna 2e p. 182-184

E6 Nutrition Monika Sharma 3e p. 237-239