A nurse is providing discharge teaching about safety considerations to an older adult client who lives at home. The client has heart failure and a new prescription for hydrochlorothiazide. Which of the following statements by the client indicates an understanding of the teaching?

A. Occupational therapist: While occupational therapists may be involved in the client's care post-stroke to address functional abilities and activities of daily living, including feeding and meal preparation, they are not specifically trained to assess and treat swallowing disorders like a speech-language pathologist.

B. Physical therapist: Physical therapists focus on improving mobility, strength, balance, and coordination. While they play a crucial role in stroke rehabilitation, particularly in addressing gait and motor deficits, they are not typically involved in the assessment and treatment of swallowing disorders.

C. Social worker: Social workers provide support and resources to clients and their families to address psychosocial and practical concerns related to illness, disability, and rehabilitation. While they may be involved in the client's care for broader support needs, they are not specifically trained to address swallowing disorders like a speech-language pathologist.

D. Speech-language pathologist

A speech-language pathologist specializes in evaluating and treating communication and swallowing disorders. In this scenario, the client's coughing during swallowing indicates a potential swallowing disorder, known as dysphagia, which is common after a stroke. The speech-language pathologist is trained to assess the client's swallowing function, identify any impairments, and develop a treatment plan to improve swallowing safety and efficiency. They may recommend strategies and exercises to address the client's coughing and prevent complications such as aspiration pneumonia.

A. Check the pH level of the client's gastric contents: To verify that the tip of the gastrostomy tube is still in the stomach, the nurse should aspirate a small amount of gastric contents and test the pH. Gastric secretions are typically acidic (pH of 5 or less), whereas intestinal or respiratory secretions usually have a higher pH. This ensures the formula is delivered into the stomach and reduces the risk of aspiration.

B. Check the patency of the client's tube every 8 hr: For intermittent feedings, patency should be checked immediately before each feeding rather than on a set hourly schedule. For continuous feedings, patency and residual volumes are usually checked every 4 to 6 hours.

C. Place the client in a supine position: This is contraindicated. To prevent aspiration, the client should be placed in a semi-Fowler's or high-Fowler's position (head of the bed elevated at least 30° to 45°) during the feeding and for 30 to 60 minutes afterward.

D. Flush the client's tube with 5 mL of water: While flushing is necessary to maintain patency, 5 mL is insufficient. The standard practice is to flush with 30 mL of water before and after each intermittent feeding and whenever the feeding is interrupted.