NG tubes and feeding Flashcards
When administering a tube feeding, we should position the patient with the head of bed elevated at least ……
30-45 degrees.
This minimizes the possibility of aspiration into the trachea
When removing a NG tube, we should ask the patient to do what?
Hold his or her breath as the tube is removed to prevent aspiration of any secretions or fluid left in the tube as it is removed
When removing the NG tube, what should we do with the tube ?
After unpinning tube from patients gown and removing adhesive tape on nose, clamp tube with fingers by doubling tube on itself
After removing the NG tube, what do we do ?
Offer mouth care to the patient and facial tissue to blow the nose
Measure and record the amount of nasogastric drainage in the collection device
examples of gastrointestinal tubes
Nasogastric, nasointestinal, percutaneous endoscopic gastronomy (PEG tube), jejunostomy (J tube)
Can all medications be crushed or altered ?
NO!
What are examples of meds that cannot be crushed or altered ?
Long acting and slow release drugs cannot be crushed
When administering medications through a NG tube, what should be done with the medications ?
If meds can be crushed, crush each pill, one at a time, to a fine powder and mix with 15-30 ml of water before delivery through the tube, keeping each medication separate from the others
How much water should be mixed with the crushed pills ?
15-30 ml
Purpose of the NG tube placement
Administer tube feedings and/or medications Establish a means for suctioning the stomach Decrease distention Decrease nausea and/or vomiting Gastric Lavage Poison Medication overdose Allowing the stomach to rest To promote healing Pre or Post surgery To obtain gastric contents for lab analysis Monitor GI bleeding
Why would we insert a NG tube to suction the stomach ?
To decrease distention, decrease nausea/vomiting, and for purposes of gastric lavage in cases of poison and medication overdose
NG tube goes through the ______________ and into the ____________
nose; stomach
a nasointestinal tube goes through the ___________ and into the ________________
nose; duodenum
A NI tube is inserted into clients who are at risk for
aspiration
Can suctioning be used with NG tubes?
Yes; NG tubes may be attached to low continuous or higher levels of intermittent suction
Why is excessive suction harmful?
It can cause mucosal damage
When inserting an NG tube, the patient should be in what position ?
High Fowlers position
Measure distance: NG tube insertion
Place tube tip at the nostril extend to the earlobe then to the xiphoid process
NEX
nostril - earlobe - xiphoid process
For NG tube measurement purposes
what size of NG tube is common ?
Size 16
For the NI tube, you should add how many inches to the NEX ?
8-12 inches
When placing an NI tube, what do you do after the tube is in the stomach ?
After the tube is in the stomach place patient on right side and allow peristalsis to advance tube (may take up to 24 hours)
make sure to _______________ the tube to allow for ease of passage and to ______ the patients head.
lubricate; lift
When inserting tube into the nostril, you should direct the tube ______________ and _______________
downward and backward
after measuring NEX, what do you do?
Make sure to mark the tube with tape at the point of measurement where it hits the xiphoid process
When inserting the NG tube, why do we have the patient touch their chin to their chest ?
Closes the trachea and opens the esophagus
Advance the tube _______ and ______________ as the patient swallows
down and back
The tube should be advanced to the point of _______
the tape marker
You should do what when the patient breathes during the procedure ?
Stop advancing the tube
you should rotate the tube __________ while inserting
180 degrees
Once NG tube is inserted, what do you do ?
Check placement Apply tincture of benzoin to tip of nose and allow to dry Facilitates attachment of the tube Face very oily Secure NG tube Tape Tube holder Secure tube with rubber band and safety pin Attach to patient gown at shoulder level Prevents tension and tugging on the tube
The NG tube is secured with
tape and tube holder on patients nose
and rubber band and safety pin on the patient’s gown at shoulder level
How do we verify placement of the NG tube ?
X ray
aspirate content- can check pH or check color/consistency
What is the most definitive placement verification ?
X-ray
What is the color/consistency of gastric fluid?
Grassy green with particles
Bile-green
Red- blood
Coffee grounds
What is the color/consistency of tracheobronchial fluid?
Off-white to tan
May be green if there is an infection
gastric pH test - pH of the stomach should be less than
5.5
the intestinal pH
7.0 or higher
Respiratory tract pH
6.0 or higher
Should I always check NG tube placement before I administer feeding or medication?
Yes! do not trust that the NG tube is in the right place- even if you inserted it two days ago or someone else inserted it yesterday and administered feeding.
Always verify for yourself
To irrigate the tube, there must be a
physician’s order
Irrigating tube
Check expiration dates on irrigating solution and set Semi-fowlers position Check placement of tube Turn off suction Disconnect tube
Select correct port
-Double lumen
-Drainage port
Draw up 30 mL of solution
If unable to irrigate
-Reposition patient, the tip may be lodged against the -wall of the stomach
- Attempt again
If no aspirate gastric return
- Inject 20 mL of air and aspirate again
-Repositions the end of the tube
To remove the NG tube or any tube, there must be a
physicians order
the decision to remove the NG tube is based on assessment of
return of bowel function
correct position for removing NG tube
semi fowlers position
Correct procedure for removing NG tube
Discontinue suction and separate tube from the suction
Unpin and remove tape
Irrigate with 10-20 mL of solution or instill air
- Removes feeding or debris
Instruct the patient to take a deep breath and hold
- Prevents accidental aspiration
Quickly remove the tube while patient hold his breath
Provide good oral care after removal
Why do we instruct the patient to take a deep breath and hold ?
This prevents aspiration as we remove the NG tube
Why do we irrigate the NG tube before removing ?
To clear it of any debris or leftover feeding
Complications of NG tube insertion
Inadvertent inserting the tube in the respiratory tract
Irritation to the wall of the stomach if continuous suction is applied
NG tube is mistakenly inserted into the respiratory tract - how would patient react
coughing, choking, cyanosis
Documenting post insertion
Type and size of tube, which nare tube inserted
Description of gastric contents
Document if attached to suction and whether it is continuous or intermittent
Patient response any nausea, assess return of bowel function
What are the 3 checks of medication administration
medication package/container should be checked at least 3 times during medication administration
Read the medication label:
1) whenever you select the container or unit dose package
2) after you take it from the drawer and compare it with the MAR - check expiration dates
3) right before giving the unit medication dose to the patient
Rights of medication administration
Right patient right medication right route right dose right time
right reason based on right assessment data - does it make sense
right documentation
right response by reassessing after administering medication
right education
right to refuse
Patients can refuse a medication if they choose. True or false
True- patients have an autonomous right to refuse a medication
Administering meds through NG tube - each dose of medication should be followed with …..
5-10 ml water flush
Pills should be crushed to a _____ _______ and mixed with how many ml of water before delivery through the tube ?
fine powder; should be mixed with 15-30 ml of water
what do we need to know before administering the medications ?
Medications actions; special nursing considerations; safe dose ranges, side effects, purpose of medication for patient - is it still appropriate
