A nurse is teaching a group of parents about expected development of gross motor skills during infancy. The nurse should teach that the following developmental tasks are expected to occur in what order? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Rationale:

A. A client who has a complete femur fracture and reports a pain level of 7 on a scale from 0 to 10: Severe pain is significant and requires timely management, but it is not immediately life-threatening compared to acute cardiac events. Pain control should follow stabilization of critical conditions.

B. A client who has left shoulder pain and S-T elevation on a 12-lead ECG: ST-segment elevation indicates a possible acute myocardial infarction, which is a life-threatening emergency. Prompt assessment and intervention are crucial to prevent cardiac damage or death, making this the highest priority.

C. A client who has Clostridium difficile and a temperature of 38.5°C (101.5°F): Fever and infection require attention, but this client is currently stable compared with someone experiencing an acute myocardial infarction. Infection control and monitoring can follow stabilization of higher-priority emergencies.

D. A client who has orthostatic hypotension and 4+ pitting edema in the lower extremities: These findings indicate fluid imbalance and cardiovascular compromise, but they are not as immediately life-threatening as an acute STEMI. Monitoring and management should follow urgent cardiac care.

Rationale:

A. Check gastric residuals every 4 hr: Monitoring gastric residual volume every 4 hours helps assess tolerance to enteral feeding and reduces the risk of aspiration. High residuals may indicate delayed gastric emptying, requiring adjustment of the feeding regimen or provider notification.

B. Check placement of the feeding tube by x-ray once daily: X-ray is the gold standard for initial confirmation of tube placement, not for routine daily checks. Ongoing verification is typically done by assessing pH of gastric aspirate and observing for signs of misplacement, making daily x-rays unnecessary and impractical.

C. Maintain the head of the client's bed at a 30° angle or higher: Elevating the head of the bed reduces the risk of aspiration during continuous enteral feedings. Proper positioning is a key intervention to promote safety and prevent complications such as pneumonia.

D. Change the feeding container and tubing every 24 hr: Changing the feeding container and tubing every 24 hours helps prevent bacterial contamination and infection. This is a standard infection-control measure in enteral feeding care.

E. Ensure the formula is cold before administration: Formula should be at room temperature before administration. Cold formula can cause gastrointestinal discomfort, cramping, and nausea, so heating it to room temperature improves tolerance and safety.