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Difficulty: Very hardBasic Care and Comfort

A practical nurse (PN) is planning care for a client who is 48 hours postoperative following a right above-the-knee amputation. The client is receiving continuous enteral nutrition via a nasogastric tube and has a prescription to be placed in the prone position for 30 minutes twice daily. Which action should the PN take to safely implement this positioning requirement?

  1. Stop the continuous enteral feeding for 30 to 60 minutes before assisting the client into the prone position.Answer
  2. B
    Disconnect the feeding tube from the pump and immediately assist the client into the prone position.
  3. C
    Maintain the continuous feeding during the procedure but ensure the client's head is turned to the side to protect the airway.
  4. D
    Place a supportive pillow directly under the right residual limb to elevate it while the client lies prone.

Answer

Stop the continuous enteral feeding for 30 to 60 minutes before assisting the client into the prone position.
The correct action demonstrates the ability to safely coordinate two conflicting care requirements. Prone positioning is essential to stretch the flexor muscles and prevent hip contractures following an above-the-knee amputation. However, placing a client flat while their stomach contains enteral formula creates a high risk for aspiration. By stopping the feeding 30 to 60 minutes beforehand, the nurse allows time for gastric emptying, protecting the airway while fulfilling the postoperative basic care prescription.

Step-by-Step Solution

1
Identify the primary clinical goals for this client.
The client needs prone positioning to prevent hip flexion contractures (post-amputation) and requires protection from aspiration due to continuous enteral feeding.
Recognizing competing physiological needs is the first step in prioritizing safe care.
2
Analyze the positioning requirements for both interventions.
Prone positioning requires the client to lie flat on their abdomen. Enteral feeding requires the head of the bed to be elevated at least 30 to 45 degrees.
Lying flat while receiving enteral feeds or immediately after feeding poses a severe aspiration risk.
3
Determine the appropriate sequencing of care.
The feeding must be paused in advance of the position change to allow for gastric emptying.
Stopping the feed 30 to 60 minutes prior ensures the stomach is relatively empty when the client is placed flat, adhering to ABC (Airway, Breathing, Circulation) prioritization while meeting basic care needs.

Key Concept

Integrating postoperative contracture prevention with aspiration precautions during enteral feeding
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Topics

Basic Care and Comfort

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