Before giving RT feeding to a child, a nurse checks the placement of the tube?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2021

Child Health Nursing (Pediatrics)

Easy

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2021

Explanation

The primary reason for checking tube placement is to prevent aspiration pneumonia, a potentially fatal complication.
Nasogastric tubes can migrate out of the stomach into the respiratory tract due to coughing, vomiting, or patient movement.
Standard nursing protocol, as a critical safety measure, mandates verifying placement immediately before each intermittent feeding or medication administration.
This ensures that the formula or medication is delivered to the stomach and not the lungs.

Option B: Checking only once a day is dangerously infrequent. A tube can become displaced at any point, and waiting up to 24 hours between checks leaves the patient at high risk for aspiration during subsequent feeds.
Option C: Checking placement after a feed is illogical and serves no preventative purpose. If the tube was misplaced, the harm (aspiration) would have already occurred.
Option D: While more frequent than once a day, checking only three times a day is still insufficient for a patient who may be receiving feeds more often (e.g., every 4 hours). The rule is to check before every feed, regardless of the daily total.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Safety protocols for nasogastric (Ryle's) tube feeding in the correct sequence, documenting the action clearly, and monitoring for the expected response.
This is a non-negotiable patient safety rule. Failure to check tube placement is a common cause of serious adverse events and is considered a breach of the standard of care.
Nurses must be proficient in the primary bedside verification method: aspirating gastric contents and testing the pH. An acidic pH (below 5.5) is a reliable indicator of stomach placement.
If a nurse is unable to confirm placement (e.g., unable to aspirate fluid, or pH is high), the feed must be held, and the issue must be escalated for further investigation, often requiring an X-ray.

How to Approach the Question

First, identify the question type. This is a procedural/safety question, asking about the correct nursing action.
Analyze the core concept: administering a nasogastric (RT) feed. The keywords are 'before giving' and 'checks placement'.
In safety-related questions, always look for the option that provides the highest level of patient protection.
Evaluate the options based on the risk of aspiration. A tube can move at any time.
Option A (Every time before feed) ensures a check is done just before the risk is introduced.
Options B and D (periodic checks) are unsafe because displacement can occur between checks.

Concept Tested & Keywords

Concept Tested: Safety protocols for nasogastric (Ryle's) tube feeding.
Stem keywords: RT feeding, child, checks placement, tube
Lead-in keywords: Before giving
Clinical cues: The question involves a child, a vulnerable population where safety procedures are paramount.
Clinical cues: The action is 'before giving' the feed, highlighting the preventative nature of the check.

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