A patient, in the intensive care unit, has been NPO for several days. The nurse is unable to assess bowel sounds. Which of the following should be included in this patient's plan to support nutritional needs?

Question

1. maintain NPO status
2. determine best enteral feeding approach and plan implementation
3. prepare to assist with implementation of a large bore venous access device to support total parenteral nutrition
4. begin oral feeding with a diet as tolerated as soon as bowel sounds return

Answer 1

2

Rationale: Readiness for enteral feeding should not be determined by the presence of bowel sounds. Active bowel sounds have been used as criteria to initiate feeding, but there is no scientific evidence to support this practice. Bowel sounds are a poor indicator of small bowel motility and nutrient absorption, as they are the result of air passing through the intestinal tract. Waiting for bowel sounds places the patient at undue risk for malnutrition. The patient should not be maintained on NPO status only because of the absence of bowel sounds. Total parenteral nutrition might expose the patient to unnecessary pathogens which could compromise the healing process. The patient may or may not be able to tolerate oral feedings with a diet as tolerated. Nutritional support should not wait until the presence of bowel sounds.