A nurse is preparing to administer an enteral feeding via an established NG tube. Identify the sequence the nurse should follow to initiate the feeding.

(Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)

Choice A rationale

Palpating the tender area first can cause increased pain and muscle guarding, potentially interfering with the subsequent auscultation of bowel sounds. It is important to auscultate before palpation to avoid altering the natural bowel sounds.

Choice B rationale

Examining the tender area last minimizes the client's discomfort and reduces the likelihood of muscle guarding affecting the assessment of other abdominal areas. This systematic approach allows for a more accurate evaluation of non-tender regions before focusing on the area of complaint.

Choice C rationale

Examining the tender area first will likely cause the patient increased discomfort, leading to muscle guarding that can make it difficult to accurately assess other areas of the abdomen. This approach can also make the patient apprehensive and less cooperative for the remainder of the examination.

Choice D rationale

Avoiding palpation of the tender area altogether would result in an incomplete assessment. Palpation is crucial for evaluating tenderness, masses, and organomegaly in the area of the patient's pain. Modifying the order of assessment is preferred over complete avoidance.

Choice A rationale

Introducing whole milk at 6 months is generally too early. At this age, an infant's primary nutrition should still come from breast milk or formula, which are specifically formulated to meet their developmental needs. The infant's digestive system is still maturing and may not be fully ready to process the higher protein and fat content of whole cow's milk.

Choice B rationale

Transitioning to whole milk at 8 months is also typically premature. While some infants might show readiness signs earlier, the American Academy of Pediatrics recommends waiting until closer to 12 months. Introducing whole milk too soon can displace the intake of breast milk or formula, potentially leading to deficiencies in essential nutrients like iron.

Choice C rationale

Waiting until 10 months is closer to the recommended timeframe, but most guidelines still advise waiting until 12 months. This allows the infant's digestive system more time to mature and ensures they receive optimal nutrition from breast milk or formula for a longer duration. Early introduction of whole milk doesn't offer any significant nutritional advantages over breast milk or formula during this period.

Choice D rationale

The American Academy of Pediatrics recommends transitioning to whole cow's milk around 12 months of age for most infants. By this time, their digestive system is more mature and capable of handling the nutrients in whole milk. Additionally, most infants at this age are consuming a wider variety of solid foods, which helps ensure they are meeting their nutritional needs beyond just milk.