Which clients should the nurse consider as candidates for an enteral access device?
1. The client who is NPO in preparation for surgery
2. The client with an absent cough and gag reflex
3. The postoperative client who returns to the unit following bowel resection who is unconscious secondary to sedation
4. The client who needs stomach contents sent for laboratory analysis
5. The client who overdosed on an oral medication
3, 4, 5
Rationale 1: The client who is NPO in preparation for surgery would not require an enteral access device at this time.
Rationale 2: The client with an absent cough and gag reflex should not have a nasogastric tube inserted, because there would be no indication if it was displaced.
Rationale 3: Indications for enteral access devices include a route for feeding the client to preventing nausea, vomiting, and gastric distention following surgery.
Rationale 4: Indications for enteral access devices include removing contents for laboratory analysis.
Rationale 5: Indications for enteral access devices include lavaging the stomach following poisoning or overdose of medication.
Global Rationale: Indications for enteral access devices include a route for feeding the client to prevent nausea, vomiting, and gastric distention following surgery; removing contents for laboratory analysis; and lavaging the stomach following poisoning or overdose of medication. The client who is NPO in preparation for surgery would not require an enteral access device at this time. The client with an absent cough and gag reflex should not have a nasogastric tube inserted, because there would be no indication if it was displaced.
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