Safe, Effective Care Environment
10. A client in rehabilitation following a brain attack is receiving tube feedings at 75 mL/hr, Na+ is 148, K+ is 4.2, creatinine is 1.2, glucose is 145. What should a nurse ask a physician, as part of the SBAR (Situation, Background, Action, Recommendation) communication?
. "Do you want to turn the feeding rate down?"
. "Do you want to start D5W IV?"
. "Do you want to give intermittent tap water through the feeding tube?"
. "Do you want to give a more concentrated formula?"
Test-Taking Tip
Interpret the laboratory data. Consider how a concentrated tube feeding will affect fluid and electrolyte levels. Use SBAR to meet client needs. Eliminate the option pertaining to rate (Answer 1). Focus on route: IV (Answer 2) vs. feeding tube (Answer 3).
Content Area: Adult Health, Gastrointestinal; Integrated Process: Nursing Process, Implementation; Cognitive Level: Analysis; Client Need/Subneed: Safe and Effective Car Environment/Management of Care/Collaboration with Interdisciplinary Team
Safe, Effective Care Environment
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Answer 1 is incorrect because there is no reason to slow the feedings down. Answer 2 is incorrect because, although D5W IV would help keep the sodium down, it is not necessary to use the IV route when the gut is working. Answer 3 is correct because full-strength tube feedings can cause hypernatremia. This is generally managed with enteral electrolyte-free water. Tap water is appropriate directly into the GI system; it does not need to be sterile. Answer 4 is incorrect because a more concentrated formula would further increase the serum sodium.