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Question

Difficulty: MediumBasic Care and Comfort

A client is scheduled to receive a bolus enteral formula via an established nasogastric (NG) tube. Which sequence of actions must the nurse execute to safely deliver this nutritional support? Arrange the clinical steps in the correct chronological order from first to last.

  1. 1Elevate the head of the client's bed to a minimum of 30 degrees.
  2. 2Aspirate the stomach contents to assess residual volume and confirm tube placement.
  3. 3Instill 30 mL of sterile water to flush the nasogastric tube.
  4. 4Administer the prescribed amount of the enteral nutritional formula.
  5. 5Flush the tube with an additional 30 mL of water and maintain the elevated bed position.

Answer

The safe sequence is to first position the client upright, verify tube placement and residual volume, perform a pre-flush with water, administer the nutritional formula, and finally execute a post-flush while maintaining the upright position.
Safe enteral feeding requires a rigorous, systematic approach to prevent life-threatening pulmonary aspiration and mechanical tube complications. Elevating the head of the bed uses gravity to protect the airway and must be done first. Verifying placement and residual volume ensures the stomach can accommodate the feed safely without reflux. The pre-flush verifies tube patency, the feeding provides necessary nutrition, and the post-flush maintains tube hygiene while continued elevation protects against post-feeding aspiration.

Step-by-Step Solution

1
Elevate the head of the client's bed to a minimum of 30 degrees.
The client is placed in an upright position.
Gravity is the primary defense against aspiration. The airway must be protected before any manipulation of the gastric tube begins.
2
Aspirate the stomach contents to assess residual volume and confirm tube placement.
Tube placement is verified and gastric emptying is assessed.
Ensuring the tube hasn't migrated to the lungs and that the stomach isn't overly full prevents pulmonary aspiration of stomach contents.
3
Instill 30 mL of sterile water to flush the nasogastric tube.
The tube is cleared and patency is confirmed.
Flushing verifies that the tube is not kinked or clogged, preparing it for the thicker formula.
4
Administer the prescribed amount of the enteral nutritional formula.
The client receives the prescribed nutrition.
With safety checks complete, the bolus feeding can be infused securely.
5
Flush the tube with an additional 30 mL of water and maintain the elevated bed position.
The tube is cleared of formula and the client remains positioned safely.
The final flush prevents the formula from coagulating and occluding the tube, while continued elevation prevents post-feeding reflux and aspiration.

Key Concept

Enteral Tube Feeding Administration Safety
Estimated Time:1m 30s
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Topics

Basic Care and Comfort

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