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Zorluk: ZorBasic Care and Comfort

An older adult client who recently had a percutaneous endoscopic gastrostomy (PEG) tube placed is receiving continuous enteral nutrition. The client has been incontinent of bowel, and the unlicensed assistive personnel (UAP) requests assistance from the practical nurse to clean the client. The UAP states, "I need to lay the bed completely flat so we can roll him safely without injuring our backs." Which instruction should the practical nurse provide to the UAP?

  1. A
    Keep the feeding pump running, but ensure we roll the client onto the left side to naturally reduce the risk of reflux.
  2. B
    I will lower the bed while you disconnect the feeding tubing from the gastrostomy port to give us more room to maneuver.
  3. We must pause the feeding pump before lowering the head of the bed, and wait to restart it until we raise the bed back up.Cevap
  4. D
    Secure the client's hands with soft restraints first, as rolling older adults flat often causes them to reflexively pull their tubes.

Cevap

The practical nurse must instruct the UAP to pause the continuous enteral feeding pump before lowering the head of the bed, and to resume the feeding only after the client is repositioned with the head of the bed elevated.
Lowering the head of the bed below 30 degrees while enteral nutrition is infusing significantly increases the risk of regurgitation and pulmonary aspiration. Even with a percutaneous endoscopic gastrostomy (PEG) tube, gravity is necessary to keep stomach contents from refluxing into the esophagus. The standard of nursing care dictates that the feeding must be paused any time the client needs to be laid flat for turning, bed-making, or hygiene, and resumed immediately upon returning the client to a semi-Fowler's position.

Adım Adım Çözüm

1
Identify the primary clinical risk factors presented in the scenario.
The client is receiving continuous enteral feeding via a PEG tube and requires a flat bed position for safe turning and hygiene care.
Recognizing competing priorities (the need for hygiene vs. the risk of aspiration) is essential for safe basic care.
2
Analyze the physiological relationship between patient positioning and enteral feedings.
Gravity is required to keep stomach contents from refluxing into the esophagus; laying the client flat eliminates this protection.
Understanding why the head of the bed must remain elevated at least 30 degrees guides the clinical decision-making process.
3
Determine the safest intervention that accommodates both the hygiene need and the physiological safety requirement.
The feeding must be paused while the bed is flat and immediately resumed once the head of the bed is returned to a safe elevation.
This intervention prevents aspiration while allowing the UAP and nurse to practice safe ergonomics during the linen change.

Anahtar Kavram

Aspiration Precautions and Enteral Feeding Positioning
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Konular

Basic Care and Comfort

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