Prior to feeding an infant by gastrostomy tube, the nurse should?

BHU NO - 2015

Child Health Nursing (Pediatrics)

Medium

Appeared in: BHU NO - 2015

Explanation

The primary and most crucial step before any enteral feeding is to confirm the tube's placement to prevent aspiration.
Aspirating the tube allows the nurse to check the gastric contents for color and pH, which helps verify its position in the stomach.
This action also measures the gastric residual volume (GRV), which indicates how well the infant is tolerating the feedings and if gastric emptying is delayed.
Confirming placement is a critical safety measure that must be performed before instilling any fluid or formula into the tube.

Option B: Instilling water is done to flush the tube and ensure it is not clogged. This is typically performed after confirming placement and before and after the feeding, not as the initial step.
Option C: Providing a pacifier is beneficial for non-nutritive sucking, which can calm the infant and aid in digestion. However, it is not a safety prerequisite for the feeding itself.
Option D: Positioning the infant with the head elevated is essential to prevent reflux and aspiration during and after the feeding. However, this must be done after confirming the tube is correctly placed in the stomach.

Clinical Relevance

Nursing practice connection: Use the key finding related to Procedure for gastrostomy tube feeding in infants to guide bedside assessment, documentation, and the next nursing action.
Failure to verify tube placement before feeding is a major cause of aspiration pneumonia, a potentially fatal complication. This is a critical patient safety issue.
Nurses must be vigilant in assessing for signs of feeding intolerance, such as large gastric residuals, abdominal distention, vomiting, or respiratory distress.
What if? If the nurse aspirates a large volume of curdled milk (e.g., more than half of the previous feeding), it indicates delayed gastric emptying. The nurse should return the aspirate per policy, withhold the current feeding, and notify the healthcare provider.

How to Approach the Question

First, identify the core of the question: what is the most important action before a G-tube feed?
This is a process-based question that requires prioritizing nursing actions based on patient safety.
Consider the potential risks associated with tube feeding. The greatest immediate risk is aspiration if the tube is misplaced.
Evaluate each option based on the 'Safety First' principle. Which action directly addresses the risk of aspiration?
Aspirating the tube (A) verifies placement. Positioning (D) reduces risk but doesn't confirm placement. Flushing (B) and providing a pacifier (C) are secondary actions.
Therefore, the action that ensures the tube is in the correct location is the highest priority.

Concept Tested & Keywords

Concept Tested: Procedure for gastrostomy tube feeding in infants
Stem keywords: gastrostomy tube, infant, feeding, prior to
Lead-in keywords: should
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

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E6 Nursing Fundamentals Potter Perry 12e Part 5 pp. 204-206, 205-207

E6 Nursing Fundamentals Taylor p. 523-525