A nurse is collecting data on a client who has impaired mobility. The nurse should monitor the client for a pressure injury due to which of the following factors?

A. Administering the feeding through a syringe barrel by gravity is an appropriate method for intermittent feedings. It is important to control the rate of administration, and gravity is commonly used for this purpose in tube feedings.
B. Aspirating gastric residuals to check for the amount of remaining formula is a standard practice before administering a tube feeding. The nurse should typically hold off on the feeding if the residual volume exceeds a certain threshold, typically 250-500 mL depending on facility guidelines. However, 50 mL of residual would not typically be a concern.
C. Allowing the client to rest in a supine position during feeding is unsafe. The client should be kept in a semi-Fowler's position (at least 30-45 degrees) to reduce the risk of aspiration and ensure that the feeding is properly digested.
D. Irrigating the NG tube with tap water after feeding is acceptable. It is common to use tap water to ensure that the tube is patent and clear, unless specific guidelines suggest otherwise.

A. Inflammation is the first phase of wound healing and typically lasts for 3-5 days. During this phase, the body works to stop the bleeding (hemostasis) and begin the healing process by preventing infection. Signs of inflammation, such as redness, swelling, heat, and pain, are commonly present during this phase.
B. Remodeling phase occurs later, after the wound has begun to heal, typically around 3 weeks after injury and can last for months to a year. It involves strengthening and reorganizing the tissue formed during healing.
C. Maturation is synonymous with the remodeling phase and also occurs after the inflammatory phase. It involves tissue maturation and scar formation.
D. Proliferation is the second phase of wound healing, where new tissue (granulation tissue) forms, and the wound begins to close. This phase follows the inflammatory phase.