NORCET 2 - 2021 (shif…: A patient is receiving continuous enteral feeding. In which position should the patient be placed to prevent…

NORCET 2 - 2021 (shift-1)

Medical & Surgical Nursing

Easy

Appeared in: NORCET 2 - 2021 (shift-1)

Explanation

The correct position for a patient receiving continuous enteral feeding is with the head of the bed elevated at a 30 to 45-degree angle (Semi-Fowler's position).
This upright position utilizes gravity to help prevent the backflow (reflux) of stomach contents into the esophagus and trachea.
Aspiration of feeding formula into the lungs is a serious complication that can lead to pneumonia and acute respiratory distress syndrome (ARDS).
This intervention is a key evidence-based practice to enhance patient safety during tube feeding.

Option B: The left lateral position does not use gravity to prevent reflux as effectively as an upright position. While it's used in other contexts (e.g., recovery position), it is not the standard for preventing aspiration during feeding.
Option C: Placing a patient in a supine (flat on their back) position is contraindicated during enteral feeding. It eliminates the gravitational barrier, making it very easy for stomach contents to flow back into the esophagus and be aspirated.
Option D: Sims' position is a side-lying posture, usually with the upper leg flexed. It is primarily used for administering enemas, rectal examinations, or to relieve pressure on the sacrum. It does not protect the airway from aspiration.

Clinical Relevance

Nursing practice connection: Use the key finding related to Aspiration prevention during enteral feeding to guide bedside assessment, documentation, and the next nursing action.
Preventing aspiration pneumonia is a critical nursing responsibility that directly impacts patient morbidity and mortality, especially in critically ill or neurologically impaired patients.
This simple, non-invasive intervention of elevating the head of the bed is one of the most effective strategies to reduce the risk of hospital-acquired pneumonia.
What if? If a patient has a spinal injury and must be kept flat (supine), a nasojejunal or post-pyloric feeding tube may be ordered. This tube bypasses the stomach, delivering formula directly into the small intestine, which significantly reduces the risk of reflux and aspiration.

How to Approach the Question

First, identify the core clinical problem: preventing aspiration during enteral feeding.
Recall the physiological mechanism of aspiration: it's the entry of foreign material (like feeding formula) into the airway, often due to reflux.
Consider how gravity affects fluid. An upright position will help keep stomach contents down, while a flat position will allow them to flow back up.
Evaluate each position based on this principle. 'Head elevated' is the only option that uses gravity to protect the airway.
Eliminate the other options by recalling their primary clinical uses (e.g., Sims' for enemas, supine for CPR), which are unrelated to safe feeding.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 5 pp. 203-205, 202-204

E6 Nursing Fundamentals Taylor p. 360-362