Feeding and Elimination — NCLEX-PN

Feeding ranges from simple meal assistance to delivering nutrition by enteral or parenteral routes. Elevate the head of bed at least 30° during and for 30 minutes after eating or a tube feeding to reduce aspiration. Allow extra time, never rush the client, and thicken liquids for dysphagia exactly as ordered.

Enteral nutrition delivers formula directly into the GI tract through an NG, G-, or J-tube when a client cannot eat safely. Verify tube placement before each use, keep the head of bed elevated at least 30°, and flush with water before, between, and after medications. Check gastric residuals per policy, holding the feeding and notifying the RN when they exceed the threshold (often 250–500 mL).

An ostomy is a surgically created opening that diverts stool or urine to the body surface through a stoma. A healthy stoma is pink-to-red and moist; a pale, dusky, or black stoma signals compromised circulation and is an emergency. Empty the pouch when it is one-third to one-half full and protect the peristomal skin with barrier products.

An indwelling urinary catheter drains the bladder continuously but is a leading cause of healthcare-associated infection, so it should be removed as soon as it is no longer clinically needed. Maintain a sterile, closed drainage system, keep the bag below bladder level to prevent backflow, and secure the tubing to avoid traction. Provide routine perineal care and never raise the bag above the bladder during transfers.

Constipation is the infrequent, difficult passage of hard stool, and opioids, immobility, low fiber, and dehydration are the most common contributors. First-line measures are increased fluids, dietary fiber, and activity; stool softeners or laxatives are added only when needed. For clients on opioids, anticipate the problem and start a bowel regimen early rather than waiting for symptoms.

Incontinence is the involuntary loss of urine or stool, which threatens both skin integrity and dignity. A timed toileting schedule — often every two hours — works better than waiting for the client to ask. Cleanse promptly after episodes and apply a moisture-barrier cream to prevent skin breakdown.

Dysphagia is difficulty swallowing and a major aspiration risk, especially after a stroke. A speech-language pathologist’s swallow evaluation determines the safe diet texture and whether liquids must be thickened. At every meal, sit the client fully upright with the chin tucked, offer small bites, allow unhurried time, and keep suction available.