Nursing Foundations · Nutritional Needs

Nutritional Needs

Dysphagiadefinition

Difficulty in swallowing.

in simple words: Trouble moving food from mouth to stomach.

e.g. Can occur in oropharyngeal or esophageal phase; risk of aspiration, malnutrition, dehydration.

Why diet matters

Patients with dysphagia need texture-modified diets to prevent aspiration and ensure adequate intake. A soft diet is recommended for difficulty chewing and swallowing due to dry mouth — its moist consistency compensates for reduced saliva. A mechanical soft diet is a soft diet with ground or minced foods for edentulous patients; it requires less chewing than a regular soft diet but is not pureed or liquid. A liquid diet is transitional after surgery and may be nutritionally inadequate, especially clear liquids. Low-fiber and low-residue diets reduce bowel stimulation, not chewing difficulty.

Diet Modifications

Diet	Use	Key point
Soft diet	Difficulty chewing/swallowing due to dry mouth	Moist, soft; nutritionally complete long-term
Mechanical soft	Edentulous patients	Ground/minced; less chewing than soft; not pureed
Liquid diet	Transitional after surgery	May be nutritionally inadequate, especially clear
Low-fiber/low-residue	Reduce bowel stimulation	Not for chewing/swallowing difficulty

Nutritional Needs · Nursing Foundations

Enteral Feeding Safety

Gavagedefinition

Administering liquid feeding directly into the stomach, commonly called tube feeding.

in simple words: Tube feeding for patients who cannot swallow or take food orally.

e.g. Used for unconscious patients, dysphagia, or after certain surgeries.

A nasogastric tube inserted through the nose for administering enteral feeding. — Nasogastric tube for enteral feeding

An enteral feeding bag used to deliver liquid nutrition through a feeding tube. — Enteral feeding bag setup

Key Safety Points

Position – Head of bed 30–45 degrees (high Fowler's, 60–90 if tolerated) during continuous feeding and at least 30 minutes after nasogastric feeding. High yield
Formula temperature – Give at room temperature; cold formula causes cramping, pain, diarrhoea. Warming encourages bacterial growth. High yield
Tube placement check – Gastric aspirate pH ≤5.5 indicates gastric placement; first-line bedside method. Chest X-ray is gold standard for initial placement. High yield
Hang time – Open systems: hang formula no more than 4 hours (max 8 hours, best practice 4 hours).

Nutritional Needs · Nursing Foundations

Enteral Feeding Safety (contd.)

Nutritional Needs · Nursing Foundations

Parenteral Nutrition

Total Parenteral Nutrition (TPN)definition

Intravenous administration of nutrients, bypassing the gastrointestinal tract.

in simple words: Feeding through a vein when the gut cannot be used.

Filter selection

Filters are essential to prevent infection and particulate matter from entering the bloodstream. The choice depends on whether lipids are present. For 2-in-1 parenteral nutrition without lipids, use a 0.22-micron filter for maximal bacterial and particulate filtration. For 3-in-1 admixtures containing lipids, use a 1.2-micron filter — lipid molecules are large and would clog a 0.22-micron filter. Standalone intravenous fat emulsions infused separately are typically not filtered.

TPN Filters

Solution	Filter size	Reason
2-in-1 (no lipids)	0.22 micron	Maximal bacterial/particulate filtration
3-in-1 (with lipids)	1.2 micron	Lipids too large for 0.22 micron; allows passage
Standalone lipid emulsion	Not filtered	Infused separately; filtering not required