The nurse is monitoring the client's ability to tolerate the tube feeding through a new g-tube. The client's gastric residual is currently 315 milliliters
Which of the following nursing interventions should be performed at this time? (Select all that apply.) 1. Increase the head-of-bed to a 45-degree angle
2. Change tube feeding setup
3. Hold tube feeding formula
4. Add blue food dye to formula
5. Consider bolus tube feeding
1, 3
Rationale: This client has an increased risk of aspirating the tube feeding formula because the gastric residual is greater than 250 milliliters. The nurse should hold the tube feeding and increase the client's head of bed to a 45-degree angle to help prevent aspiration of tube feeding and aspiration pneumonia. The tube feeding setup should be changed each day to help prevent a foodborne illness, but it is not important to change it at this point related to the increased gastric residual. Blue dye should not be added to the tube feeding formula because it can cause skin, organ, and body fluid discoloration and has been associated with death in some patients. Bolus feedings should be avoided because they are associated with an increased risk of aspiration.
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After reviewing information about postpartum blues, a group of students demonstrate understanding when they state which of the following about this condition?
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The staff nurse has a question regarding an employment benefit. The nurse manager is unable to answer the question and suggests that the nurse contact the human resources department
The nurse states, "Oh never mind, they are so unfriendly down there and can never help you anyway." This statement reflects what basic issue? 1. The nurse's inability to ask the question logically. 2. The nurse manager's incompetence in being unable to answer the question. 3. The human resources department's failure to demonstrate support for the employees. 4. The nurse's laziness in not seeking out the answer.