A nurse is providing teaching to the parent of a newborn who has gastroesophageal reflux. Which of the following instructions should the nurse include?

Gastroesophageal reflux (GER) is a common condition in infants where the contents of the stomach flow back into the esophagus. It often resolves on its own as the infant grows, but management strategies can help alleviate symptoms. Positioning the newborn upright or at a slight angle after feeding is a key recommendation to reduce reflux episodes.

Now, let's review the rationales for each option:

A) "Provide a small feeding just before bedtime." - Feeding a newborn just before bedtime can exacerbate reflux symptoms as lying down can increase the likelihood of stomach contents refluxing into the esophagus. Therefore, this instruction is not recommended as it may worsen GER symptoms.

B) "Dilute formula with 1 tablespoon of water." - Diluting formula with water can disrupt the balance of nutrients and calories in the formula, potentially affecting the infant's growth and nutritional status. Additionally, diluting formula does not address the underlying cause of GER and is not a recommended practice.

C) "Position the newborn at a 20-degree angle after feeding." - This instruction is correct. Placing the newborn at a 20-degree angle or slightly upright after feeding can help reduce the occurrence of reflux episodes by allowing gravity to assist in keeping stomach contents down. This position helps prevent the backflow of gastric contents into the esophagus and reduces discomfort for the infant.

D) "Place the newborn in a side-lying position if vomiting." - Placing the newborn in a side-lying position after vomiting may increase the risk of aspiration, especially in young infants. It is safer to position the infant upright or at a slight angle to minimize reflux and reduce the risk of aspiration.

A) Change to a low-calorie formula if diarrhea persists: Switching to a low-calorie formula is not the initial action for managing diarrhea in a client receiving continuous enteral nutrition. Diarrhea in these clients can result from various factors, including formula intolerance, medication side effects, or infections. Before changing the formula, the nurse should assess for potential causes of diarrhea and implement appropriate interventions.

B) Warm the formula to room temperature before infusing: This is the correct action. Cold formula may cause cramping and diarrhea in some clients. Warming the formula to room temperature before infusion can help prevent gastrointestinal discomfort and reduce the risk of diarrhea. However, the nurse should ensure that the formula is not heated excessively, as excessive heat can degrade certain nutrients.

C) Replace the extension tubing every 48 hours: While replacing the extension tubing regularly is important for preventing bacterial contamination and maintaining the integrity of the enteral feeding system, it is not directly related to managing diarrhea in a client receiving continuous enteral nutrition.

D) Increase the rate of infusion: Increasing the rate of infusion is not typically indicated for managing diarrhea in clients receiving enteral nutrition. In fact, increasing the infusion rate may exacerbate diarrhea and lead to fluid and electrolyte imbalances. The nurse should monitor the client's fluid balance closely and adjust the infusion rate based on the client's clinical status and tolerance.