A nurse is initiating an intermittent enteral feeding for a client who has a new gastrostomy tube. Which of the following actions should the nurse take first?

A. Ground meat: Ground meat is good for a mechanically altered diet because it can be easily chewed and swallowed compared to whole cuts of meat. The texture is soft and can be modified further if necessary, making it suitable for clients with difficulty chewing or swallowing. It provides a good source of protein, essential for recovery and tissue repair.
B. Raw broccoli: Raw broccoli is not suitable for a mechanically altered diet, as it can be difficult for a client to chew properly and may pose a choking hazard. Vegetables with tough, fibrous textures require further modification, such as cooking or pureeing, to ensure safe consumption for individuals with swallowing difficulties.
C. Strawberries: Strawberries, although soft, are not ideal for a mechanically altered diet, particularly if they are whole or in large pieces. The seeds and texture may still pose a risk for choking or difficulty swallowing. To include strawberries safely, they would need to be pureed or cut into very small pieces, which is not the most efficient choice for a mechanically altered diet.
D. Mashed potatoes: Mashed potatoes are a good choice for a mechanically altered diet because they are soft, smooth, and easy to swallow, which helps prevent choking or aspiration. Mashed potatoes can also be flavored with various ingredients, providing nutritional value and palatability while adhering to the requirements for a mechanically altered diet.
E. Ice cream: Ice cream can be included in a mechanically altered diet because it has a soft, smooth texture that is easy to swallow. Additionally, it can provide a source of calories and protein, which may be especially beneficial for clients who have difficulty maintaining adequate nutrition after a stroke. However, it should be offered in moderation, as it is high in sugar and fat.

A. Offer the client a selection of beverages at each meal: Providing a variety of beverages may offer hydration and a sense of control, but clients with anorexia nervosa often use fluids to avoid calorie-dense solid foods. This approach can reinforce avoidance behaviors and does not contribute meaningfully to nutritional rehabilitation or psychological recovery.
B. Inform the client that a weight gain of 2.3 kg (5 lb) per week is expected: A weight gain goal of 2.3 kg per week is too aggressive and may provoke anxiety or resistance from the client. A slower, more gradual goal of 0.5 to 1 kg (1 to 2 lb) per week is considered safer and more psychologically tolerable. Unrealistic expectations can harm rapport and may lead to nonadherence or relapse.
C. Arrange for someone to remain with the client for 30 min after meals: Monitoring after meals is essential to prevent purging or other compensatory behaviors. The standard is 60 to 90 minutes post-meal observation to address delayed attempts at purging or exercising. Thus, while well-intentioned, this time frame is insufficient.
D. Encourage the client to participate in developing dietary goals: Involving the client in setting dietary goals promotes a sense of autonomy, collaboration, and ownership in the recovery process. This approach is therapeutic, reduces power struggles, and helps build trust between the nurse and the client.