In a child returned to the pediatric intensive care unit after cardiac surgery with a left chest tube attached to water-seal drainage, an intravenous line running D5 ½ NS at 4 mL/h, and a double-lumen nasogastric tube connected to continuous suction, which is the priority nursing intervention?

• A. Auscultating breath sounds
• B. Testing the level of consciousness
• C. Measuring drainage from both tubes
• D. Determining the suction pressure of the nasogastric tube

Answer: (D)

After cardiac surgery, keeping the stomach decompressed helps prevent gastric distention that can push against the diaphragm, hinder lung expansion, and compromise venous return to the heart. Because the nasogastric tube is on continuous suction, ensuring that the suction pressure is correct directly affects the patient’s respiratory and hemodynamic stability. If suction is not at the prescribed level, the stomach won’t decompress effectively, increasing the risk of vomiting or aspiration and potential cardiac strain. Therefore, first confirm and adjust the suction pressure of the nasogastric tube to the prescribed setting to keep the stomach decompressed and protect cardiopulmonary function. Once that is secured, other assessments like breath sounds, chest-tube drainage, and neurologic status remain important but are not the immediate priority.