Through the gut, when the gut still works

Enteral nutrition, in this account, is feeding through the digestive tract. It is used when the gut has no obstruction and still works, but what a person can eat falls short of what is needed. It is treated as less costly than feeding by a vein, and as carrying fewer infectious and non-infectious complications. Complications still occur; the most common named here are diarrhea and gastrointestinal bleeding.

The feed can be given in three ways. A bolus is a set volume pushed by syringe in fifteen minutes or less. Intermittent feeding gives 2,000 to 3,000 millilitres at intervals of four to six hours, by gravity or a pump, over thirty to sixty minutes. Continuous feeding runs slowly, also by gravity or a pump, over twenty to twenty-four hours.

The nursing around a nasogastric tube is practical and close. Before the tube is placed, and before feeding starts, its position should be checked, and residual volume in the stomach watched as feeding goes on. The feed is kept at about the temperature of the room, and the tube is flushed before and after a drug is given.

Through a vein, when the gut cannot

Parenteral nutrition supplies some or all of what is needed through a peripheral vessel or a great vein, without passing through the stomach. It is used when, for one reason or another, the gut cannot take nutrients. The account sorts it into peripheral parenteral nutrition, central parenteral nutrition, and full parenteral nutrition through a catheter in a central vein.

A peripheral line is easy to reach and useful as a supplement, but it cannot fully replace protein, and the needle can injure the vein. When a peripheral line is used, the insertion site is to be changed every forty-eight to seventy-two hours, and the catheter every seventy-two hours. A central line, because a catheter must be placed in a central vein, carries a risk of local infection at the insertion site. Because complications are more likely than with enteral feeding, the nursing is described as needing closer watching.

Diabetes is introduced beside this feeding work as a chronic illness in which insulin is short, or does not work as it should. Acute trouble includes a high blood sugar that can bring diarrhea, abdominal pain, and vomiting, and, if it deepens, dehydration and coma, which asks for fluid, electrolytes, insulin, and a hospital stay; and ketoacidosis, in which the body’s fluid turns acidic and consciousness can be lost, also treated first in hospital by addressing the cause. Hypoglycemia is given as a blood sugar of 50 milligrams per decilitre or below, often after too much insulin or an oral glucose-lowering drug, with sweating, a rapid pulse, tingling in the fingers, dizziness, and palpitations, and, if it lasts, loss of consciousness and harm to the brain. If the person is unconscious, food should not be forced; they should be taken to hospital for glucose or glucagon. Among longer complications the account names diabetic nephropathy, in which protein leaves in the urine and which can go on to chronic renal failure, needing a transplant or ongoing dialysis, and care of the person’s mind as well; diabetic retinopathy, a loss of sight from microcirculation in the retina, to be caught by regular examination after diagnosis; and cerebral infarction, against which the prevention of atherosclerosis is placed first.

Mr. Kim, sixty-five, learning the needle

The person assessed is a 65-year-old man, called Kim, who lives with his wife and is retired, with no other work. About ten years earlier, a health checkup found diabetes and high blood pressure. He is 168 centimetres tall and weighs 63 kilograms. He does not yet have complications from either illness, and no special family history is given.

His appetite has been falling day by day, and his tastes have been changing; foods he used to like have sometimes become unpleasant, and his intake has gone out of balance. His weight has been dropping. A skinfold measured by pinching is about 9 millimetres, a little under the adult-male average used here.

The teaching started with meals, treated as the base of diabetes care: three meals a day, a better balance of nutrients, and no alcohol, which can bring hypoglycemia. His eating and his meal times had been uneven; after steady teaching they improved somewhat. He had not given himself insulin before, and found it very hard. The teaching covered the syringe, the choice of site, how to mix the insulin, and how to place the needle, and it was not closed until he had been seen to do it steadily, several times. By the end, he could give himself insulin safely.

What the two kinds of feeding, and the teaching, are for

The point is to know which route the body can still use, to watch that route closely, and, when a man is still eating and learning a needle, to start with the meal in front of him. The same Korean report, at fuller length, is on CampusDown.

Sources

1. Account of enteral and parenteral nutrition — methods, indications, advantages and drawbacks, and nursing — with a diabetes case (Korean source page).
2. Kim Bo-hyeong, Ajou University, 2009, on diarrhea and nutritional status by method of enteral infusion. Kim Su-mi, Sungkyunkwan University, 2014, on nutritional status and support in an intensive-care unit. Seol Eun-mi, Ju Dal-rae, and Lee Hyeok-jun, Korean Society for Parenteral and Enteral Nutrition, 2016, on nutrition-screening tools for inpatients.
3. Lee Seon-ok and Cho Nam-ok, Adult Nursing, Korea National Open University Press, 2014. Choi Yun-gyeong and Jeong Seong-hui, Adult Nursing, Korea National Open University Press, 2018. Lee Seong-pyo, Chung-Ang University, 2011, on commercial enteral formulas in a geriatric hospital. Im An-cho, Chungnam National University, 2018, on self-care and self-efficacy in type 2 diabetes.
4. Kim Eun-seon, Jeonbuk National University, 2007, on an exercise and nutrition program in type 2 diabetes. Kim Min-gyeong, Yonsei University, 2006, on an education program for adolescents with type 1 diabetes and their families. Korean Diabetes Association, as linked in the source.

Last updated: 14 November 2026