Chelsea Green is a 16-year-old white young woman brought to the health clinic today by her mother, Lisa Green.
Chelsea is a sophomore high school student who appears extremely underweight.
Lisa has been concerned for a while and decided that she needs to be seen by a health care professional.
Chelsea is not pleased to be at the appointment but agreed to come.
Rachael is a 30-year-old student nurse assigned to Sylvia, who is the nurse practitioner at the clinic.
They go in to see Chelsea.
Mrs.
Green tells them that Chelsea has been eating only small amounts and then works out 3 to 4 hours each day.
Chelsea tells them that she does not want to get fat like her mother.
On assessment, Chelsea's body mass index is 17. Lisa Green asks Rachael if she can recommend a healthy diet for her as well.
She tells Rachael that she has gained 20 lb in the past few years and is overweight as Chelsea pointed out.
To what resource sponsored by the USDA could Rachael refer Mrs.
Green?

Choice A rationale

Sterile water is not the preferred solution for routine irrigation of a gastrostomy tube. Typically, tap water is recommended for irrigation in most home and long-term care settings for established PEG tubes, as it is cost-effective and generally safe. Sterile water is usually reserved for initial post-operative irrigation or in immunocompromised patients as per specific physician orders.

Choice B rationale

Keeping the head of the bed elevated at least 30 degrees is crucial for a client with a gastrostomy tube, especially one who has dysphagia and is at high risk for aspiration. Elevating the head of the bed helps to prevent reflux of stomach contents into the esophagus and subsequent aspiration into the lungs, reducing the risk of aspiration pneumonia. This position should be maintained during and after feedings and medication administration.

Choice C rationale

While maintaining oral hygiene is important for all patients, including those with gastrostomy tubes, moistening the client's lips with lemon glycerin swabs is generally discouraged. Lemon glycerin swabs can dry out the mucous membranes of the mouth and may not provide adequate hydration. Plain water or a moisturizing oral swab is a better choice for maintaining oral comfort.

Choice D rationale

Measuring the client's abdominal girth can be a useful assessment for detecting abdominal distension, which might indicate feeding intolerance or other complications related to the gastrostomy tube. However, it is not a primary intervention immediately following PEG tube placement. Ensuring proper positioning to prevent aspiration is a more critical initial intervention for a client with dysphagia.

Choice A rationale

Checking gastric residual volume is essential before administering enteral feedings and medications to assess for delayed gastric emptying, which could increase the risk of aspiration. A high residual volume (typically >500 mL or >250 mL on two consecutive checks) may indicate intolerance to the feeding.

Choice B rationale

Turning the client on their left side after administering enteral feedings and medications is not the recommended position. The right lateral decubitus position is preferred as it promotes gastric emptying by allowing gravity to assist the flow of the feeding into the small intestine.

Choice C rationale

Elevating the head of the bed to a 30-45 degree angle during and for at least 30-60 minutes after enteral feedings significantly reduces the risk of aspiration pneumonia. This position utilizes gravity to help keep the feeding within the stomach and prevent reflux into the esophagus and airway.

Choice D rationale

Leaving the client in their position of comfort while feeding them is incorrect. Maintaining an elevated head of bed position (30-45 degrees) is crucial during and after feeding to prevent aspiration, regardless of the client's perceived comfort. A flat or semi-recumbent position increases the risk of regurgitation and subsequent aspiration into the lungs.