The nurse is preparing to administer an intermittent bolus enteral feeding via a gastrostomy tube to a client with dysphagia. After verifying the provider's prescription, performing hand hygiene, and donning clean gloves, arrange the following nursing actions in the correct chronological sequence.
- 1Position the client with the head of the bed elevated to at least 30 degrees.
- 2Aspirate and measure the gastric residual volume.
- 3Flush the gastrostomy tube with 30 mL of water.
- 4Administer the prescribed enteral feeding formula via gravity.
- 5Flush the gastrostomy tube with an additional 30 mL of water.
Cevap
Elevate the head of the bed, check the gastric residual volume, perform an initial water flush, administer the feeding formula by gravity, and perform a final water flush.
The safest and most effective sequence for administering a gastrostomy tube feeding prioritizes airway protection first (elevating the head of the bed). Once the airway is protected, the nurse assesses the client's physiological tolerance (checking residual volume). After establishing it is safe to proceed, the nurse maintains equipment integrity (initial flush), delivers the therapeutic intervention (gravity feed), and finally secures the equipment for future use (final flush).
Adım Adım Çözüm
Anahtar Kavram
Safe administration of intermittent enteral nutrition via gastrostomy tube