A nurse is assessing a client who is at 36 weeks of gestation. Which of the following findings should the nurse report to the provider?

A. Apply sterile gloves: Standard precautions are followed when handling feeding equipment, but sterile gloves are not required for routine administration of intermittent gastric feedings. Clean gloves are sufficient to prevent contamination.

B. Assess gastric residual volume: Checking gastric residual volume before feeding helps evaluate the client’s tolerance of the previous feeding and reduces the risk of aspiration. High residual volumes may indicate delayed gastric emptying and the need to hold or adjust the feeding.

C. Flush the tube with 60 mL of sodium chloride: Flushing the tube is important before and after feedings to maintain patency, but the amount and timing depend on institutional protocol. It is performed after assessing residual volume rather than as the first step.

D. Chill the formula: Feeding formulas should generally be at room temperature to prevent gastrointestinal discomfort and cramping. Chilling the formula is not recommended prior to administration.

A. A 14-year-old child who eats small but frequent meals throughout the day: This is an appropriate intervention for gastroesophageal reflux, as smaller, more frequent meals reduce gastric distention and minimize reflux episodes. No revision to the plan of care is needed for this child.

B. A 16-year-old child who takes their proton pump inhibitor 30 min before meals: Administering proton pump inhibitors before meals is correct because these medications are most effective when taken prior to food intake, allowing for optimal acid suppression. The current plan aligns with best practice.

C. A 6-year-old child who underwent a Nissen fundoplication and is tolerating a full liquid diet: Progressing to a full liquid diet after Nissen fundoplication is appropriate and indicates the child is tolerating postoperative dietary advancement. The plan of care is appropriate and requires no changes.

D. A 4-month-old child who is experiencing weight loss: Weight loss in an infant with gastroesophageal reflux is concerning and indicates inadequate nutrition or complications. The plan of care should be revised to address feeding adequacy, possible medical interventions, and close monitoring of growth and hydration status.