A nurse is caring for a client who is to receive a mechanically altered diet. Which of the following client food choices necessitates intervention by the nurse?

A. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain and inflammation. While it does not directly affect bowel obstruction, NSAIDs can cause gastrointestinal irritation and potentially worsen symptoms in some patients. However, it is not the primary medication to withhold due to a small bowel obstruction.
B. Omeprazole is a proton pump inhibitor (PPI) that reduces stomach acid. It is generally safe to use in the context of a small bowel obstruction because it does not affect bowel motility directly. It might be used to manage symptoms related to acid reflux or gastritis, which could be secondary issues in a patient with SBO.
C. Senna is a stimulant laxative used to promote bowel movements. In the context of a small bowel obstruction, administering a laxative like Senna is contraindicated because it can worsen the obstruction by increasing bowel motility or causing further distention. The primary goal in treating an SBO is to relieve the obstruction, and using a laxative could complicate the situation.
D. Zolpidem is a sedative-hypnotic used for short-term management of insomnia. It does not directly impact bowel function or obstruction. While not ideal for all patients, it does not specifically exacerbate a small bowel obstruction.

A. The supine position increases the risk of aspiration, where food or liquid could enter the airway and potentially cause aspiration pneumonia. To minimize this risk, the client should be positioned in a semi- Fowler’s position (head of the bed elevated at 30-45 degrees) during feedings.
B. Aspirating gastric residual volumes is a standard practice to check for proper digestion and tolerance of the feeding. Generally, a residual of up to 250-500 mL can be acceptable depending on institutional policy and client condition. This action does not necessarily require intervention unless specific guidelines indicate otherwise.
C. Irrigating the NG tube with tap water is a common practice to ensure the tube remains patent and to help clear any residual feeding material from the tube. Tap water is generally considered acceptable for this purpose, though some facilities may use sterile or distilled water to avoid any potential infections.
D. Administering the feeding through a syringe barrel by gravity is a standard method for intermittent tube feedings. This technique allows the feeding to flow slowly into the stomach without excessive pressure, which can help prevent complications such as nausea or cramping.