The nurse aspirates fluid from the nasointestinal tube. Which finding requires the nurse to plan follow-up nursing interventions?
a. The aspirated liquid totals 5 mL of green-ish fluid.
b. The feeding tube collapses with negative pressure.
c. The nurse aspirates a small amount of the formula.
d. The aspirated liquid appears pale and straw colored.
D
The nurse plans follow-up nursing interventions after aspirating pale and straw-colored fluid be-cause intestinal aspirate should be green, indicative of the bile concentration of the fluid. Because the aspirate is inconsistent with clinical indicators for intestinal fluid, the nurse investigates further to verify tube placement before instilling anything into the nasointestinal tube. The nurse expects to aspirate a small amount of greenish fluid indicative of bile in the fluid. This also indi-cates placement of the nasointestinal tube in the intestines because the intestines cannot hold large amounts of fluid as the stomach can. The nasointestinal tube is expected to collapse with negative pressure because it is a soft pliable tube. A small amount of formula aspirated is not a problem and does not require follow-up. It is acceptable.
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