A nurse is planning care for a client who is receiving continuous enteral tube feedings through an open system. Which of the following interventions should the nurse include in the plan of care?

A. Maintain bed elevation at 20°: The head of the bed should be elevated to at least 30° to 45° during enteral feedings to reduce the risk of aspiration. A 20° angle is inadequate for preventing reflux and potential aspiration. B. Flush the tubing with 30 ml of water every 4 hr: Routine flushing of the feeding tube helps maintain patency and prevent clogging. Flushing every 4 hours is standard practice for continuous feedings to ensure uninterrupted delivery. C. Place enough formula in the container to last 18 hr: Open system formula should be discarded after 4 hours to reduce the risk of bacterial contamination. Filling the container for 18 hours exceeds safe hang time recommendations. D. Check for gastric residual every 12 hr: Gastric residuals should typically be checked every 4 to 6 hours for continuous feedings, or per facility policy. Waiting 12 hours may delay the identification of feeding intolerance or complications.