A nurse is preparing to insert a client's NG tube for enteral feedings. Which of the following actions should the nurse take first?

Correct answer: The client is most at risk of developing atelectasis and paralytic ileus.

Rationale for correct answers:

• atelectasis: The client is 6 hours postoperative, drowsy from morphine, and has shallow breath sounds. Narcotic pain medications suppress the cough reflex and decrease deep breathing, leading to the collapse of alveoli (atelectasis). This is further evidenced by the slight drop in oxygen saturation (95% to 94%) and the decrease in respiratory rate.
• paralytic ileus: The client has hypoactive bowel sounds and has undergone abdominal surgery. General anesthesia and opioid analgesics (morphine) both slow down intestinal motility. If peristalsis does not return or remains severely suppressed, the client can develop a paralytic ileus (a non-mechanical bowel obstruction).

Rationale for incorrect answers:

• urinary tract infection: This is not the primary risk at this time. The client’s urinary catheter was removed, and the client has already successfully voided 350 mL of clear urine, indicating good bladder function and a low immediate risk for UTI.
• delayed wound healing: While a risk for any surgical client, this client denies diabetes and peripheral vascular disease (Exhibit 1), which are the primary risk factors for delayed healing. The dressing is currently dry and intact.
• deep vein thrombosis: Although a general risk for postoperative clients, this client is wearing sequential compression devices (SCDs) and has even pedal pulses with no edema, indicating that preventive measures are in place and working.

A. Brittle hair: Protein-calorie malnutrition often leads to hair that is dull, dry, and brittle, and may eventually fall out (alopecia) due to the lack of nutrients required for hair follicle health.

B. Yellow conjunctivae: This is a sign of jaundice (icterus), usually indicating liver dysfunction or hemolysis, rather than general malnutrition.

C. Clubbing of the fingernails: This is typically a sign of chronic hypoxia (low oxygen levels) associated with cardiac or pulmonary disease, not specifically malnutrition.

D. Bradycardia: While severe starvation can slow the heart rate, tachycardia (a fast heart rate) is a more common finding in the early stages of malnutrition or dehydration.