A nurse is completing a nutritional assessment of a female client. Which of the following findings should indicate to the nurse that the client is at an increased risk for developing cancer?

A. Elevate the head of the bed: Raising the head of the bed to at least 30 to 45 degrees is the first and most essential action to reduce the risk of aspiration during enteral feeding. This position helps ensure that the formula flows into the stomach by gravity and minimizes the potential for reflux of gastric contents into the lungs, which can lead to aspiration pneumonia.
B. Attach the barrel of the syringe to the tube after removing the plunger: This step is necessary for gravity-based enteral feeding when using a syringe. However, it should only be done after confirming tube placement and ensuring the patient is positioned properly. Attaching the syringe before proper safety precautions increases the risk of aspiration.
C. Insert air into the tube before pulling back gastric contents: Injecting air into the gastrostomy tube is part of the verification process to confirm tube placement, often followed by aspirating gastric contents. While this is important, it is not the very first action. The client's head must be elevated first to ensure safety before any manipulation of the tube begins.
D. Flush the tube with 30 mL water: Flushing is necessary to ensure tube patency and to prevent blockage before and after feedings. However, it is not the first step in the procedure. Elevating the head of the bed comes before flushing to prevent aspiration during any subsequent feeding or fluid administration.

• Malabsorption syndrome: While steatorrhea indicates fat malabsorption, this diagnosis is too general. The client’s symptoms are more likely linked to recent pelvic radiation, making a treatment-induced etiology more probable. There is no evidence of chronic GI disease or a primary malabsorption disorder that predates cancer treatment.
• Tumor lysis syndrome: Typically presents with hyperuricemia, hyperkalemia, and acute kidney injury due to rapid tumor breakdown, not GI symptoms. The client’s vital signs and urine output are stable, with no lab evidence of metabolic abnormalities or renal failure.
• Radiation enteritis: Caused by radiation damage to the small bowel, common in pelvic cancer treatments like for endometrial cancer. Symptoms such as nausea, steatorrhea, abdominal pain, and anorexia strongly support this diagnosis, especially within a week of initiating radiation.

• Steatorrhea : Fatty stools indicate impaired fat absorption due to inflammation of the intestinal lining, consistent with radiation-induced enteritis. This is a key symptom supporting a diagnosis related to intestinal damage from radiation.
• Metallic taste: Common with chemotherapy but non-specific; it does not indicate the underlying cause of malabsorption or abdominal discomfort. While notable, it’s not as critical as steatorrhea for identifying radiation enteritis.
• Constipation: The client reports two bowel movements today, so constipation is not present and contradicts the clinical picture. Steatorrhea, rather than absence of bowel movements, suggests increased motility or malabsorption.