A nurse is preparing to administer a scheduled intermittent bolus feeding via a percutaneous endoscopic gastrostomy (PEG) tube for an older adult client recovering from a stroke. Arrange the following nursing actions in the correct sequence of performance. (Place the first action at the top and the last action at the bottom.)
- 1Elevate the head of the bed to 30 to 45 degrees.
- 2Aspirate the gastric contents, measure the residual volume, and return the aspirate.
- 3Flush the gastrostomy tube with 30 mL of water.
- 4Administer the prescribed enteral feeding formula by gravity flow.
- 5Flush the gastrostomy tube with an additional 30 mL of water and clamp the tube.
Answer
The correct sequence is: 1) Elevate the head of the bed, 2) Aspirate and measure residual volume, 3) Flush with 30 mL of water, 4) Administer the feeding formula, 5) Flush with a final 30 mL of water and clamp.
The safe administration of an enteral tube feeding follows a logical sequence to protect the airway, assess tolerance, and maintain equipment. The nurse must first elevate the head of the bed to 30 to 45 degrees to utilize gravity in preventing aspiration. Next, the nurse aspirates and measures the gastric residual volume to ensure the previous feeding has been digested, returning the aspirate to maintain electrolyte balance. The tube is then flushed with 30 mL of water to verify patency. Afterward, the formula is administered by gravity to avoid overwhelming the stomach, which can cause cramping or dumping syndrome. Finally, the tube is flushed with another 30 mL of water to clear the lumen of formula, preventing occlusions, and the tube is clamped.
Step-by-Step Solution
Key Concept
Safe administration of enteral tube feedings