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Difficulty: MediumBasic Care and Comfort

A registered nurse (RN) is planning morning hygiene care for a client who has right-sided hemiparesis and is receiving continuous enteral nutrition. The RN is delegating parts of the care to an unlicensed assistive personnel (UAP). Which instruction provided by the RN is the most appropriate?

  1. A
    Maintain the head of the bed at a 45-degree elevation while you turn the client side-to-side to wash their back.
  2. B
    Turn off the enteral feeding pump temporarily before you lower the head of the bed to change the linens.
  3. Please notify me when you are ready to begin so I can pause the enteral feeding pump before the bed is lowered.Answer
  4. D
    Apply soft wrist restraints if the client becomes agitated and attempts to pull on the feeding tube during the bath.

Answer

The most appropriate instruction is to have the UAP notify the RN so the RN can pause the feeding pump before the bed is lowered.
The correct answer protects the client from aspiration while ensuring care is performed safely and within legal scopes of practice. To properly bathe the back and change linens, the client must be rolled side-to-side. Doing this with the head of the bed elevated causes harmful shearing forces on the skin and is physically difficult. Therefore, the bed must be lowered. Because the client is on continuous enteral feeding, lowering the bed without pausing the feeding creates a severe aspiration risk. Since managing the feeding pump is strictly an RN responsibility, the UAP must coordinate with the RN to pause the feeding before repositioning the bed.

Step-by-Step Solution

1
Identify the primary risks associated with the client's current treatments during hygiene care.
The client receives continuous enteral feeding (risk of aspiration if flat) and requires turning for a bath (risk of shearing if elevated).
Understanding competing safety needs dictates the correct sequence of care.
2
Determine the necessary positioning for a complete bed bath and linen change.
The bed should be lowered to a flat or nearly flat position to safely roll the client and minimize skin shearing.
Proper ergonomics and skin protection are essential components of basic care and comfort.
3
Apply delegation principles and aspiration precautions to the required positioning.
The RN must intervene to pause the feeding pump before the UAP lowers the bed, as UAPs cannot manage the pump.
Maintaining the client's airway and adhering to scope of practice are non-negotiable safety standards.

Key Concept

To prevent aspiration during basic hygiene care, continuous enteral feedings must be paused by the RN before lowering the head of the bed to turn the client.
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Topics

Basic Care and Comfort

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