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Components of a Nutrition Care Bundle: What Anyone with an MSN Should Know

Knowing how to treat malnutrition can be an important part of helping patients and succeeding in your nursing career.

Malnourishment is a significant problem for many hospital patients. In fact, over half of all critical care patients are malnourished,1 which puts them at an increased risk for a wide range of health complications and raises the likelihood of mortality.

Any nurse working in a hospital setting—and particularly any nurse serving in nursing management—needs to know how to treat malnourishment. Fortunately, there are guidelines developed by the American Society for Parenteral and Enteral Nutrition (ASPEN).1 Termed the “nutrition bundle,” these guidelines include six components. The components are:

Components of a Nutrition Care Bundle: What Anyone with an MSN Should Know

Assessment of Malnutrition

Many malnourished patients are not easily identified as such without the help of a screening tool. Because early detection is key to treatment, you should screen patients early in their admission. You can use any of the common nutrition assessment tools, including the Nutrition Risk Screening 2002, the Nutrition Risk in Critically Ill (NUTRIC) score, and the Malnutrition Universal Screening Tool (MUST). According to ASPEN’s guidelines, a patient can be considered malnourished if an assessment shows them to be exhibiting two of the following six characteristics: insufficient energy intake, weight loss, loss of muscle mass, loss of subcutaneous fat, localized or generalized fluid accumulation, and diminished functional status as measured by handgrip strength.1

Initiation and Maintenance of Enteral Feeding

Enteral feeding is the providing of nutrition through a tube leading into the patient’s gastrointestinal tract. When properly implemented, it can significantly raise caloric intake without significantly increasing the risk of other complications.2 Malnourished patients should begin enteral feeding within 24 to 48 hours of admission.

Reduction in Aspiration

Some patients are predisposed to aspiration. To minimize this risk, you need to take several precautions when administering enteral feeding. These include: “keeping the head of [the] bed elevated 30 to 45 degrees, using sedatives sparingly, assessing placement of the enteral access device and tolerance to enteral feeding every four hours, and ensuring adequate bowel function and defecation.”1

Implementation of Enteral Feeding Protocols

Nurse-implemented protocols empower nurses and lead to nurses having a more active role in patient care. That is why you should follow proper protocols when administering enteral feeding. By doing so, you can significantly improve patient outcomes.

Avoiding Use of GRV Values to Determine Tolerance

In the past, some believed that measuring a patient’s gastric residual volume (GRV) could help nurses determine whether a patient was properly digesting the enteral feeding. However, new research has shown that measuring GRV is not a useful way to assess a patient’s tolerance to enteral feeding and can, in fact, lead to complications or undernutrition. Better assessments include “vomiting, abdominal distention, complaints of abdominal discomfort, diarrhea, reduced passage of flatus, and abnormal findings on abdominal radiographs.”1

Early Initiation of Parenteral Feeding When Enteral Feeding Cannot Be Started

If enteral feeding cannot be initiated in a highly malnourished patient at the time of admission, you should instead implement parenteral feeding (nutrition supplied through an IV). However, parenteral feeding has more risks of complication, requiring careful monitoring. If a patient is not highly malnourished, you can wait seven days to implement parenteral feeding, if enteral feeding is still not possible.

How Can You Learn More About Caring for Patients?

One of the best ways to improve your ability to care for patients and advance you nursing career is to earn a Master of Science in Nursing (MSN degree). Through an MSN program, you can gain advanced nursing skills and put yourself in position to be a nurse leader, whether you want to be a nurse practitioner, nurse educator, or nurse manager.

If earning a master’s degree in nursing sounds like the right path to you, but you’re unsure how to make attending nursing school feasible, take a look at online education. Through an online MSN program, you can take your courses over the internet, saving you from having to live close to or drive to a campus. On top of that, online nursing schools feature flexible scheduling, giving you the power to choose when in the day you attend class. That can allow you to keep working all your shifts while attending your master’s in nursing program.

Malnutrition is just one of the many health issues you’re likely to face during your career in nursing. By earning a master’s in nursing online, you can gain the expertise you’ll need to provide the best possible care.

Walden University is an accredited institution offering a Master of Science in Nursing degree program online. Expand your career options and earn your degree in a convenient, flexible format that fits your busy life.


Walden University is accredited by The Higher Learning Commission,