S: Situation A concise statement of the problem The patient is a 65-year-old female with a G-tube who is currently NPO, experiencing symptoms of vomiting (projectile, observed formula content), and showing signs of fever and tachycardia. The GT tube is leaking, liquids are moving slowly, and there is potential tube migration, further complicated by abdominal distention. B: Background Pertinent and brief information related to the situation The patient has a G-tube used for nutritional intake due to a severe medical condition resulting in severe neurologic impairment, which was caused by being hit by a car while walking on the street, resulting in issues with swallowing. The change in her condition and the presence of projectile vomiting require urgent intervention. A: Assessment Analysis and consideration of options - what you found Vital Signs: Elevated HR (tachycardia) and fever may indicate an infection or significant stress response. G-tube Assessment: Leakage and slow movement of formula suggest possible blockage or misplacement. The G-tube has been observed to move when the patient coughs. Indicating it may not be securely positioned. An abdominal assessment reveals distention (round and hard), which could indicate a buildup of gas or fluid, possible obstruction, or other GI complications. R: Recommendations Action requested/recommended - what you want Immediate medical assessment is required: X-Ray to verify G-tube positioning and check for any obstruction