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NURS 327 Medical Surgical Nursing > NG tubes and feeding > Flashcards

NG tubes and feeding Flashcards

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1
Q

When administering a tube feeding, we should position the patient with the head of bed elevated at least ……

A

30-45 degrees.

This minimizes the possibility of aspiration into the trachea

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2
Q

When removing a NG tube, we should ask the patient to do what?

A

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

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3
Q

When removing the NG tube, what should we do with the tube ?

A

After unpinning tube from patients gown and removing adhesive tape on nose, clamp tube with fingers by doubling tube on itself

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4
Q

After removing the NG tube, what do we do ?

A

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

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5
Q

examples of gastrointestinal tubes

A

Nasogastric, nasointestinal, percutaneous endoscopic gastronomy (PEG tube), jejunostomy (J tube)

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6
Q

Can all medications be crushed or altered ?

A

NO!

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7
Q

What are examples of meds that cannot be crushed or altered ?

A

Long acting and slow release drugs cannot be crushed

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8
Q

When administering medications through a NG tube, what should be done with the medications ?

A

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

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9
Q

How much water should be mixed with the crushed pills ?

A

15-30 ml

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10
Q

Purpose of the NG tube placement

A 
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
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11
Q

Why would we insert a NG tube to suction the stomach ?

A

To decrease distention, decrease nausea/vomiting, and for purposes of gastric lavage in cases of poison and medication overdose

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12
Q

NG tube goes through the ______________ and into the ____________

A

nose; stomach

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13
Q

a nasointestinal tube goes through the ___________ and into the ________________

A

nose; duodenum

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14
Q

A NI tube is inserted into clients who are at risk for

A

aspiration

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15
Q

Can suctioning be used with NG tubes?

A

Yes; NG tubes may be attached to low continuous or higher levels of intermittent suction

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16
Q

Why is excessive suction harmful?

A

It can cause mucosal damage

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17
Q

When inserting an NG tube, the patient should be in what position ?

A

High Fowlers position

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18
Q

Measure distance: NG tube insertion

A

Place tube tip at the nostril extend to the earlobe then to the xiphoid process

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19
Q

NEX

A

nostril - earlobe - xiphoid process

For NG tube measurement purposes

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20
Q

what size of NG tube is common ?

A

Size 16

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21
Q

For the NI tube, you should add how many inches to the NEX ?

A

8-12 inches

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22
Q

When placing an NI tube, what do you do after the tube is in the stomach ?

A

After the tube is in the stomach place patient on right side and allow peristalsis to advance tube (may take up to 24 hours)

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23
Q

make sure to _______________ the tube to allow for ease of passage and to ______ the patients head.

A

lubricate; lift

24
Q

When inserting tube into the nostril, you should direct the tube ______________ and _______________

A

downward and backward

25
Q

after measuring NEX, what do you do?

A

Make sure to mark the tube with tape at the point of measurement where it hits the xiphoid process

26
Q

When inserting the NG tube, why do we have the patient touch their chin to their chest ?

A

Closes the trachea and opens the esophagus

27
Q

Advance the tube _______ and ______________ as the patient swallows

A

down and back

28
Q

The tube should be advanced to the point of _______

A

the tape marker

29
Q

You should do what when the patient breathes during the procedure ?

A

Stop advancing the tube

30
Q

you should rotate the tube __________ while inserting

A

180 degrees

31
Q

Once NG tube is inserted, what do you do ?

A 
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
32
Q

The NG tube is secured with

A

tape and tube holder on patients nose

and rubber band and safety pin on the patient’s gown at shoulder level

33
Q

How do we verify placement of the NG tube ?

A

X ray

aspirate content- can check pH or check color/consistency

34
Q

What is the most definitive placement verification ?

A

X-ray

35
Q

What is the color/consistency of gastric fluid?

A

Grassy green with particles
Bile-green
Red- blood
Coffee grounds

36
Q

What is the color/consistency of tracheobronchial fluid?

A

Off-white to tan

May be green if there is an infection

37
Q

gastric pH test - pH of the stomach should be less than

A

5.5

38
Q

the intestinal pH

A

7.0 or higher

39
Q

Respiratory tract pH

A

6.0 or higher

40
Q

Should I always check NG tube placement before I administer feeding or medication?

A

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

41
Q

To irrigate the tube, there must be a

A

physician’s order

42
Q

Irrigating tube

A 
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
43
Q

To remove the NG tube or any tube, there must be a

A

physicians order

44
Q

the decision to remove the NG tube is based on assessment of

A

return of bowel function

45
Q

correct position for removing NG tube

A

semi fowlers position

46
Q

Correct procedure for removing NG tube

A

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

47
Q

Why do we instruct the patient to take a deep breath and hold ?

A

This prevents aspiration as we remove the NG tube

48
Q

Why do we irrigate the NG tube before removing ?

A

To clear it of any debris or leftover feeding

49
Q

Complications of NG tube insertion

A

Inadvertent inserting the tube in the respiratory tract

Irritation to the wall of the stomach if continuous suction is applied

50
Q

NG tube is mistakenly inserted into the respiratory tract - how would patient react

A

coughing, choking, cyanosis

51
Q

Documenting post insertion

A

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

52
Q

What are the 3 checks of medication administration

A

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

53
Q

Rights of medication administration

A 
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

54
Q

Patients can refuse a medication if they choose. True or false

A

True- patients have an autonomous right to refuse a medication

55
Q

Administering meds through NG tube - each dose of medication should be followed with …..

A

5-10 ml water flush

56
Q

Pills should be crushed to a _____ _______ and mixed with how many ml of water before delivery through the tube ?

A

fine powder; should be mixed with 15-30 ml of water

57
Q

what do we need to know before administering the medications ?

A

Medications actions; special nursing considerations; safe dose ranges, side effects, purpose of medication for patient - is it still appropriate

NURS 327 Medical Surgical Nursing (6 decks)

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