Final answer:
In response to a large volume of gastric residual before a bolus enteral feeding, the nurse should hold the next feeding, potentially flush the nasogastric tube per facility protocol or healthcare provider guidance, notify the healthcare provider, and elevate the head of the client's bed. Continuing with the feeding is not appropriate.
Step-by-step explanation:
The student is asking about the appropriate nursing actions when encountering a large volume of residual gastric contents prior to administering an enteral bolus feeding. When the nurse notes 250 mL of bright green fluid as residual in a nasogastric tube check, several steps should be considered:
- Hold the next feeding: A large volume of residual (usually greater than 200-250 mL) can indicate delayed gastric emptying, increased risk of aspiration, or other complications. Therefore, the feeding should be temporarily stopped.
- Flush the nasogastric tube with water: This is important for maintaining tube patency, but the decision to flush should take into account the total amount of residual observed and the patient's overall condition. It might be appropriate to hold off on flushing until after consulting with the healthcare provider due to the large volume of residual noted.
- Notify the healthcare provider: Given the significant residual volume, contacting the healthcare provider is important for further assessment and potential modification of the feeding plan.
- Elevate the head of the client's bed: This should be done to minimize the risk of aspiration, particularly if the feeding is put on hold.
Option 'e' is not appropriate given the amount of residual observed. Ongoing assessment and close monitoring of the situation are important to ensure patient safety in enteral nutrition.