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Difficulty: Very hardBasic Care and Comfort

A practical nurse is assigned to care for a client who receives continuous medical nutrition via a percutaneous endoscopic gastrostomy (PEG) tube. The client recently underwent a complex lumbar laminectomy that was complicated by a dural tear. The surgeon has prescribed strict bed rest in a completely flat (0-degree) supine position to prevent a cerebrospinal fluid leak. Which action should the practical nurse implement to safely manage this client's basic care needs?

  1. Pause the continuous PEG feeding immediately and report the conflicting positional requirements to the registered nurse.Answer
  2. B
    Elevate the head of the bed to 30 degrees strictly during the enteral feeding to prevent aspiration pneumonia.
  3. C
    Maintain the flat, supine position and continue the PEG feeding while positioning the client's head turned strictly to the right side.
  4. D
    Assign the unlicensed assistive personnel (UAP) to continuously monitor the client for signs of aspiration while the feeding infuses.

Answer

The correct action is to pause the continuous PEG feeding immediately and report the conflicting positional requirements to the registered nurse.
The correct answer identifies a direct and dangerous conflict between standard nutritional care and post-operative safety. Standard practice dictates that continuous enteral feedings require the head of the bed to be elevated at least 30 degrees to prevent aspiration. However, a dural tear strictly requires a flat, 0-degree supine position to prevent a cerebrospinal fluid leak. Because it is physically impossible to safely accommodate both fundamental requirements, the practical nurse must prioritize immediate physiological safety by pausing the feeding and escalating the conflict to the registered nurse or provider for an alternative nutritional or hydration plan.

Step-by-Step Solution

1
Analyze the surgical prescription.
The client must remain completely flat (0-degree elevation) to prevent a cerebrospinal fluid (CSF) leak from the dural tear.
Post-operative positioning requirements for a dural tear are absolute to ensure proper healing and prevent neurological complications.
2
Evaluate the basic care intervention (enteral feeding).
Continuous PEG feedings require the head of the bed to be elevated to at least 30 to 45 degrees.
Elevation utilizes gravity to prevent gastric reflux and life-threatening aspiration of the formula into the lungs.
3
Synthesize the findings to identify the conflict.
A direct physiological contraindication exists between the required flat position for the dural tear and the required elevated position for the enteral feeding.
The nurse cannot safely implement both interventions simultaneously.
4
Determine the priority nursing action.
The nurse must pause the feeding and notify the registered nurse or healthcare provider.
Operating within the practical nurse scope of practice requires halting unsafe interventions and escalating conflicting orders for resolution (e.g., initiating temporary IV fluids or total parenteral nutrition).

Key Concept

Synthesis of enteral nutrition safety, post-operative positioning constraints, and scope of practice prioritization.
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Topics

Basic Care and Comfort

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