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Zorluk: OrtaBasic Care and Comfort

An older adult client is completely immobile and receiving continuous enteral nutrition via a gastrostomy tube. The nursing team is preparing to provide perineal care and perform a complete bed linen change, which will require lowering the bed. Which nursing action is the most appropriate to ensure the client's safety during this basic care procedure?

  1. Suspending the continuous enteral feeding pump prior to lowering the head of the bed.Cevap
  2. B
    Placing the client in a completely flat, supine position while the feeding infusion continues.
  3. C
    Delegating the pre-procedure evaluation of the client's lung sounds to the unlicensed assistive personnel.
  4. D
    Attributing the client's sudden onset of lethargy and confusion to normal aging and proceeding with care.

Cevap

The safest approach is to suspend the continuous enteral feeding pump prior to lowering the head of the bed for the linen change.
When providing basic care that requires lowering the head of the bed, such as a complete linen change or bed bath, it is critical to pause continuous enteral feedings. Keeping the head of the bed elevated at least 30 degrees is standard practice to prevent regurgitation and aspiration. Lowering the bed without first pausing the feeding significantly increases the risk of aspiration pneumonia.

Adım Adım Çözüm

1
Identify the need for basic hygiene care and a linen change.
The procedure will require the client to be turned and the head of the bed to be lowered.
To facilitate safe rolling, proper spinal alignment, and movement during the bed bath and linen replacement.
2
Suspend the continuous enteral feeding pump.
The infusion of nutritional formula is temporarily halted.
Prevents the introduction of formula into the stomach while the client is supine, thereby reducing the risk of gastric reflux and aspiration.
3
Lower the head of the bed and perform the necessary hygiene care.
The linen change is completed safely without compromising the client's airway.
A flat position prevents shearing forces during turning, while the paused feeding ensures airway protection.

Anahtar Kavram

Aspiration Precautions During Enteral Feeding
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Konular

Basic Care and Comfort

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