The nurse is preparing to gavage feed a preterm infant who is receiving IV antibiotics. The infant expels a bloody stool. What nursing action should the nurse implement?

• A. Institute contact precautions.
• B. Obtain a rectal temperature.
• C. Assess for abdominal distention.
• D. Decrease the amount of the feeding.

Answer: (C)

Bloody stool in a preterm infant who is gavage-fed raises strong concern for necrotizing enterocolitis (NEC), a serious GI condition that can progress rapidly. The most informative early sign to evaluate is abdominal distention. By carefully examining the abdomen, palpating for firmness, and noting any tension or wholeness of the abdomen, you gain crucial information about the bowel status. Abdominal distention in this context often precedes worsening symptoms and can trigger urgent actions, such as pausing feeds and notifying the physician for further evaluation and imaging.

Other actions aren’t as directly informative at this moment for guiding immediate management: instituting contact precautions isn’t indicated by bloody stool alone unless an infectious process is suspected; taking a rectal temperature doesn’t address the GI concerns as effectively; and decreasing the feeding amount is a management step that follows assessment and physician orders rather than something to initiate based solely on the finding of bloody stool.