Which of the following actions by the nurse may reduce risk of aspiration in a patient with a continuous tube feeding?

A - 4
B - 2
C- 3
D- 5
E- 1

A. Hold feeding, notify physician, maintain patient in semi-Fowler's position, and recheck in 1 hour.
B. Turn off tube feeding, place in Fowler's position, suction, and notify physician.
C. Reposition patient, attempt to flush with large-bore syringe and warm water; if able to flush and absence of residual, determine the patient's risk of dislodgment—if risk is low and the tube has remained taped in original position, start next feeding.
D. Notify physician and confer with dietitian to determine need to modify type of formula, concentration, or rate of infusion.
E. Withhold tube feeding and notify physician. Be sure tubing is patent; aspirate for residual.

Definitions
1) Patient develops nausea and vomiting
2) Patient aspirates formula
3) Unable to aspirate gastric contents
4) Gastric residual exceeds 250 mL
5) Patient develops diarrhea

If gastric residual exceeds 250 mL (use agency policy), the nurse should hold the feeding and notify the health care provider. The patient should be maintained in the semi-Fowler's position or at least have the head of the bed elevated 30 degrees. The nurse should check the residual again in 1 hour. If the patient aspirates formula, the patient may exhibit the following symptoms: rapid and shallow respirations, ashen color, rhonchi upon auscultation of breath sounds, and coughing up secretions that are similar to tube feeding. The nurse should turn off the tube feeding immediately, position the patient in the Fowler's position, suction, and notify the health care provider immediately. Prepare for chest x-ray examination. If unable to aspirate gastric contents, reposition the patient, attempt to flush with large-bore syringe and warm water; if able to flush and absence of residual, determine the patient's risk of dislodgment—if risk is low and the tube has remained taped in its original position, start the next feeding. If unable to flush, notify the health care provider. If the patient develops diarrhea three or more times in 24 hours, indicating intolerance, notify the health care provider and confer with the dietitian to determine the need to modify the type of formula, concentration, or rate of infusion. Determine whether patient is receiving antibiotics and medications containing sorbitol, which can induce diarrhea. If the patient develops nausea and vomiting, it may indicate gastric ileus. Withhold the tube feeding and notify the health care provider. Be sure the tubing is patent; aspirate for residual.

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