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Difficulty: MediumBasic Care and Comfort

A nurse is preparing to administer a prescribed intermittent enteral tube feeding to a client. Arrange the following nursing actions in the correct chronological order.

  1. 1Position the client with the head of the bed elevated to at least 30 degrees.
  2. 2Verify tube placement and check the gastric residual volume.
  3. 3Flush the enteral tube with 30 mL of water.
  4. 4Administer the prescribed intermittent enteral feeding formula.
  5. 5Flush the enteral tube again with 30 mL of water.

Answer

The correct sequence is to first elevate the head of the bed, verify tube placement and residual volume, flush the tube to confirm patency, administer the enteral feeding, and finally flush the tube again.
Safe administration of an intermittent enteral feeding follows a specific clinical protocol to prevent severe complications such as aspiration and tube occlusion. The nurse must first elevate the head of the bed to at least 30 degrees to minimize aspiration risk. Next, tube placement and gastric residual volume are assessed to ensure gastrointestinal readiness. The tube is then flushed with water to confirm patency. After these safety measures are complete, the feeding formula is administered. Finally, a post-feeding flush is performed to clear the tubing and prevent clogging.

Step-by-Step Solution

1
Position the client with the head of the bed elevated.
The client is in a safe, upright position.
Elevating the head of the bed to at least 30 degrees uses gravity to prevent reflux and decreases the risk of aspiration.
2
Verify tube placement and check the gastric residual volume.
Tube location is confirmed and gastric emptying is assessed.
This ensures the feeding will go directly into the stomach and that the client is safely digesting previous feedings.
3
Flush the enteral tube with 30 mL of water.
The tube is cleared and patency is confirmed.
Flushing verifies that the tube is not blocked before introducing the viscous feeding formula.
4
Administer the prescribed intermittent enteral feeding.
The client receives the required nutrition.
The formula is administered only after safety checks and patency are clearly established.
5
Flush the enteral tube again with 30 mL of water.
The tube is cleared of any remaining formula.
A post-feeding flush prevents the formula from clogging the tube and reduces the risk of bacterial growth inside the lumen.

Key Concept

Enteral Tube Feeding Administration
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Topics

Basic Care and Comfort

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