Problem 5 - Clinical Nursing Skills and Techniques

Question

An older adult had a recent stroke and is receiving home enteral nutrition. Which action(s) should the nurse have instructed the family caregiver to take if the client begins to have difficulty breathing and coughing? (Select all that apply.) 1 Call the health care provider. 2 Raise the head of the bed. 3 Verify tube placement. 4 Stop the feeding.

Step-by-Step Solution

Answer

Stop the feeding, raise the head of the bed, and call the healthcare provider.

Step 1: Assess the Situation

If the client begins to have difficulty breathing and coughing, the first step is to identify that this might be due to aspiration or another serious complication related to enteral feeding.

Step 2: Stop the Feeding

The immediate action to prevent further complications is to stop the enteral feeding. This will remove the immediate cause of the potential aspiration or airway obstruction.

Step 3: Raise the Head of the Bed

To help with breathing difficulties and reduce the risk of aspiration, elevate the head of the bed to a minimum of 30-45 degrees. This position helps to prevent the contents of the stomach from entering the airways.

Step 4: Call the Health Care Provider

Once the immediate risk is managed by stopping the feeding and elevating the head, notify the healthcare provider. They need to assess the client's condition and may provide further instructions or treatment if necessary.

Key Concepts

Aspiration Prevention

Aspiration is a serious concern, especially when it comes to elderly patients receiving enteral nutrition. It occurs when food, liquid, or other substances enter the airways, possibly leading to lung infections like pneumonia. For preventing aspiration during enteral feeding, caregivers and patients need to focus on a few key actions:

• Ensure the patient's head is elevated to 30-45 degrees during and after feeding.
• Regularly assess the tube placement to confirm it's correct.
• Pause feeding if any signs of aspiration, like coughing or breathing difficulty, are observed.

By following these precautions, aspiration risks can be significantly reduced, safeguarding the patient's health and comfort.

Caregiver Instruction

Caregivers play a crucial role in the management of enteral nutrition at home. Effective instruction is essential to ensure they can provide safe and competent care. Key areas of focus include:

• Understanding the signs of potential complications, such as aspiration, and knowing when to stop feeding.
• Learning the correct procedures for verifying tube placement, which can prevent dangerous misplacements.
• Knowing how to appropriately elevate the head of the bed to prevent aspiration.
• Recognizing when to contact a healthcare provider for further advice or in case of emergencies.

Instruction should also be simple and straightforward to empower caregivers in making informed, timely decisions.

Elderly Patient Care

Caring for elderly patients requires special considerations and a compassionate approach. They are often more vulnerable to complications such as aspiration due to age-related changes in swallowing and respiratory function. To optimize care:

• Always perform a thorough assessment of the patient's health status and capabilities.
• Adapt feeding practices to their individual needs and health conditions.
• Ensure they remain in a comfortable and safe position before, during, and after feeding.

It's also essential to monitor for any changes in their health status and adjust care accordingly to prevent risks.

Home Healthcare

Enteral nutrition in a home healthcare setting provides a more comfortable environment for patients but also comes with unique challenges. Successful management includes:

• Creating a safe and supportive home environment for both patients and caregivers.
• Establishing clear communication lines with healthcare providers for guidance and emergencies.
• Continuously educating both caregivers and patients about new practices and technologies in enteral nutrition.
• Considering psychological and social support for patients, as home-based care can impact emotional well-being.

With adequate planning and support, home healthcare can be a positive and effective way to manage enteral nutrition.