A 68-year-old patient with a gastrostomy tube has just completed enteral feeding. As the nurse prepares to continue care, which of the following is the priority intervention immediately after feeding?

1. A

   Reposition the patient to left lateral side

2. B

   Check for abdominal distension

3. C

   Flush the tube with sterile water

4. D

   Maintain upright position

Appeared in: NORCET 9 Mains - 2025

Explanation

Listen in Hindi

• The primary goal after enteral feeding is to prevent aspiration, which is a life-threatening complication.
• Maintaining an upright position (semi-Fowler's or high-Fowler's, 30-45 degrees) uses gravity to help keep the stomach contents down and prevent reflux into the esophagus and lungs.
• This position should be maintained for at least 30 to 60 minutes after an intermittent feeding is completed.
• This intervention directly addresses patient safety by protecting the airway, which is always the highest priority according to the ABCs (Airway, Breathing, Circulation) of nursing care.

Why Other Options Were Wrong

• Option A: Repositioning the patient to the left lateral side does not effectively use gravity to prevent reflux and may even increase the risk compared to an upright position.
• Option B: Checking for abdominal distension is an assessment of feeding tolerance that should be performed before administering the feed, not as the priority action after.
• Option C: Flushing the tube is essential for maintaining patency and preventing clogs, but it is a procedural step, not an immediate safety priority. Airway protection (preventing aspiration) takes precedence over equipment maintenance.

Related Visual

• Visual 1: Diagram: A diagram illustrating the correct semi-Fowler's position (head of bed elevated 30-45 degrees) for a patient receiving enteral feeding, showing how gravity helps prevent gastric reflux.
• Visual 2: Flowchart: A flowchart outlining the steps for administering an intermittent enteral feeding, highlighting 'Maintain upright position for 30-60 min' as the critical step immediately following the feed.

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Priority nursing interventions following enteral feeding in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Preventing aspiration pneumonia is a critical nursing responsibility. This complication significantly increases patient morbidity, mortality, and length of hospital stay.
• Nurses must educate patients and their families on the importance of proper positioning during and after feeds, especially in the home care setting.
• What if the patient has a spinal injury and cannot be placed in a semi-Fowler's position? The nurse should use a reverse Trendelenburg position to elevate the head of the bed while keeping the spine straight, still using gravity to reduce aspiration risk.

How to Approach the Question

• First, identify the core of the question: it asks for the 'priority' action 'immediately after' an event.
• Analyze the options in the context of patient safety. Use the ABC (Airway, Breathing, Circulation) framework to prioritize.
• Recognize that enteral feeding creates a risk of gastric reflux and aspiration, which is a direct threat to the patient's airway.
• Evaluate each option based on its ability to mitigate this primary risk. Maintaining an upright position directly addresses airway safety by preventing aspiration.
• Compare this to the other options. Flushing the tube (C) is about equipment patency, not immediate life safety. Checking distension (B) is an assessment, usually done before, not a priority intervention after. Left lateral position (A) is incorrect for preventing aspiration.
• Conclude that the intervention that best protects the patient's airway is the highest priority.

Concept Tested & Keywords

• Concept Tested: Priority nursing interventions following enteral feeding.
• Stem keywords: gastrostomy tube, enteral feeding, priority intervention, immediately after feeding
• Lead-in keywords: priority
• Clinical cues: The phrase 'immediately after feeding' is a critical time-based cue that directs the nurse to prioritize immediate safety over routine procedural steps.

Question ID

QY0iY_v8DtVi-RONiBnlMq

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