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The number of residents receiving enteral feedings has increased as more acutely ill residents are cared for in extended care facilities. The complications which may occur with enteral feedings can be life-threatening to the resident and frustrating to the nursing staff. Residents frequently have had the feeding tube inserted on an outpatient basis. The tolerance to enteral feedings which was previously established in the acute care setting is now shifted to the extended care setting.
An understanding of the complications and the necessary interventions can reduce the incidence of complications and enhance the care of these residents. This article will complement the article in the last issue of Nursing Homes ("Principles of Caring for Residents with Feeding Tubes," November/December, p. 37) by describing common complications, including gastrointestinal, respiratory, metabolic and mechanical problems.
GASTROINTESTINAL COMPLICATIONS
Gastrointestinal complications are the most common complications experienced by residents receiving enteral feedings,(1) and diarrhea is the most common gastrointestinal complication, occurring in up to 25 % of those receiving enteral feedings.(2) There are many factors which may contribute to diarrhea in residents, including:
MALNUTRITION
Commonly, the residents who require enteral feedings are malnourished with low serum albumin (protein) levels, which is why the enteral feedings are required. Malnutrition leads to changes in the gastrointestinal tract which affect the absorption of nutrients. Starvation leads to atrophy of the villi (absorptive structures) of the small intestine, decreasing the ability of these cells to absorb nutrients. Also, the mucosal cells of the small intestine frequently become edematous with malnutrition, thus reducing absorptive capacity.(3) Utilizing the gut for enteral feeding promotes hyperplasia of the mucosal cells and the return of normal functioning.(4) However, the return of normal functioning is a gradual process, and diarrhea will need to be controlled in the interim.
MEDICATIONS
The use of medications is common in older adults. When combined with enteral feedings, determining if the medication or the feeding is causing the diarrhea becomes essential. Antibiotics may alter the normal flora and motility of the bowel and lead to diarrhea. Use of antibiotics may also lead to overgrowth of the Clostridium difficile toxin, which causes frequent loose stools and must be treated aggressively.(5)
Other medications which commonly cause diarrhea are antacids containing magnesium, cimetidine and other histamine blockers, and...