Mr. White has been admitted to the alcoholic referral unit in the local hospital. Based on an understanding of the effects of alcohol on the GI tract, which of the following would the nurse be most alert for nutritionally?

Appetite stimulation in hospitalized clients can be challenging due to illness, hospital routines, and unfamiliar foods. Nurses play a crucial role in promoting nutrition by addressing barriers such as pain, treatment schedules, and food preferences.

Rationale for correct answer:

2. Encouraging food from home when possible: Familiar foods can enhance appetite, provide comfort, and increase food intake.

Rationale for incorrect answers:

1. Administering pain medication after meals: Pain should be controlled before meals to improve comfort and willingness to eat. Giving it after meals does not promote appetite.

3. Scheduling his respiratory therapy before each meal: Treatments before meals may tire or stress the client, reducing appetite. They should ideally be scheduled after meals.

4. Reinforcing the importance of his eating exactly what is delivered to him: Strict enforcement can create resistance and does not address appetite stimulation. Flexibility is more effective.

Take home points:

• Appetite is best stimulated with comfort measures such as familiar, preferred foods.
• Nursing interventions should reduce barriers to eating (pain, fatigue, dislike of hospital food) rather than enforce strict compliance.

Gravity tube feeding relies on hydrostatic pressure to deliver formula from a bag through the feeding tube. Safe technique includes correct bag height to regulate flow, positioning the patient to reduce aspiration risk, checking residuals per policy, and warming formula to room temperature for tolerance.

Rationale for correct answer:

1. Hang the feeding bag 1 foot higher than the tube’s insertion point into the client: This provides adequate hydrostatic pressure for a controlled gravity flow while reducing need for excessive bolus pressure. Always regulate flow with the roller clamp and monitor the patient.

Rationale for incorrect answers:

2. Administer the next feeding only if there is less than 25 mL of residual volume from the previous feeding: A 25 mL cutoff is unrealistically low. Traditional thresholds for holding feedings have been much higher.

3. Place client in the left lateral position: The safest position for enteral feeding to reduce aspiration is upright (high-Fowler’s) or at least a 30°-45° elevated head of bed.

4. Administer feeding directly from the refrigerator: Cold formula can cause cramping and poor tolerance; feeding solutions should be warmed to room temperature before administration.

Take home points

• Position the patient upright (head of bed 30°- 45°) during and for at least 30 - 60 minutes after gravity tube feeding to lower aspiration risk.
• Use the roller clamp to control the gravity flow; always follow facility policy for residual-volume checks and feeding procedures.