A patient is receiving enteral feedings via a small-bore nasogastric tube. Which finding requires immediate intervention?

A gastric residual aspirate of 350 mL for the second consecutive time indicates a potential problem with the patient's ability to tolerate the enteral feeding. This situation suggests that the stomach is not emptying properly, which could lead to complications such as aspiration pneumonia or abdominal distension. High residual volumes may be a sign of delayed gastric emptying or an adverse reaction to the formula, necessitating immediate assessment and possible intervention to prevent further issues. Monitoring gastric residuals is a critical part of managing patients on enteral feedings, as it helps ensure that the patient is digesting and absorbing the formula adequately.

In this context, other findings, such as a gastric pH of 4.0, indicate acidity which is expected in the stomach, and a weight gain of 1 pound over a week may fall within acceptable limits. Active bowel sounds suggest gastrointestinal activity, which is positive. Hence, although they are monitored, they do not indicate an urgent need for intervention like the high gastric residual does.