The initiation of enteral tube feeding should be delayed when the patient is

• A. Hemodynamically unstable
• B. Decreased level of consciousness
• C. Without bowel sounds
• D. Scheduled for discharge

Answer: (A)

Feeding should be delayed when the patient is hemodynamically unstable because adequate gut perfusion is essential for enteral nutrition to be tolerated and safe. In shock or with high-dose vasopressors, splanchnic blood flow is compromised, so starting enteral feeds can worsen gut ischemia, increase the risk of feeding intolerance, and potentially lead to complications like mucosal injury. Once perfusion and hemodynamics stabilize—often with vasopressor weaning or dose reduction—feeding can be started cautiously, sometimes at a trophic rate and then advanced as tolerated. The other scenarios do not inherently require delaying feeding: decreased level of consciousness alone isn’t a contraindication if the airway is protected; absence of bowel sounds is not a reliable indicator of intolerance; and being scheduled for discharge simply reflects stability.