Nutritional Care

Question 1

The nasogastric (NG) tube is used to _____ the stomach.

Answer 1

intubate

Question 1

Describe pathway of the NG tube.

Answer 1

nose –> nasopharynx –> esophagus –> stomach

Question 2

What are some of the purposes of a NG tube?

Answer 2

• Decompress the stomach by removing fluids or gas to promote abdominal comfort
• To allow surgical anastomoses to heal w/o distention
• To decrease risk for aspiration
• To administer meds to pts who are unable to swallow
• To provide nutrition by acting as a temporary feeding tube
• To irrigate the stomach and remove toxic substances i.e. poisoning

Question 3

What is the pt’s position during NG tube insertion?

Answer 3

High-Fowler’s

Question 4

How you determine the NG tubing length that will be used for the pt?

Answer 4

• Measure the length of the tube from the pt’s nose bridge to the earlobe to the xiphoid process (NEX). Remember to place a tape to mark this length.
• NEX: Nose, earlobe, and xiphoid process

Question 5

When would you instruct pt to swallow or take small sips of water during NG tube insertion? Unless contraindicated

Answer 5

When the tube is near the back of the throat aka when the pt starts to gag and cough

Question 6

How should you maneuver the NG tube if you are met with resistance going down the throat?

Answer 6

Slowly rotate and ai the tube downward and toward the closer ear; have the pt’s head flexed toward the chest while passing the tube

Question 7

Whenever there is any change in the pt’s respiratory status during NG tube insertion, what do you do?

Answer 7

Immediately stop the procedure and withdraw the tube

Question 8

Why does the pt get an abdominal x-ray after NG tube insertion?

Answer 8

To confirm placement of tube. X-ray is the gold standard.

Question 9

How can you engage the pt during NG tube insertion?

Answer 9

Prior to performing the procedure, inform the pt the purpose and different ways that they help to make the procedure go smoothly.

Question 10

If the NG tube is to be connected to the suction, when would you set up the suction apparatus?

Answer 10

Prior to NG tube insertion.

Question 11

If NG tube is going to be connected to a suction apparatus, what are the 3 main components of the suction apparatus?

Answer 11

• Canister
• Connector tube
• NG tube adaptor

Question 12

It is important to determine which nostril is more patent prior to NG tube insertion. TRUE or FALSE.

Answer 12

TRUE. B/c the NG tube is inserted through the nose and into the stomach:

Question 13

How to you prevent outflow of the stomach during NG tube insertion in the stomach?

Answer 13

Occlude one end of the NG tube before inserting, using the plug end of the vent valve OR snugly insert the tip of a piston style irrigation syringe into the open end of the NG tube

Question 14

How can you determine if the NG tube is correctly placed in the stomach?

Answer 14

• Chest x-ray (Gold standard)
• Aspirate w/ syringe and measure for acidic pH (1-4)
• Using syringe to blow air through the tube and auscultate for sounds in abdomen

Question 15

Lubricate 3-4 inches of the tip of the NG tube with a small amount of _____-soluble lubricant

Answer 15

water. Avoid using petroleum-based lubricant due to risk for aspiration.

Question 16

How should the pt position their neck at the beginning of NG tube insertion?

Answer 16

Have the pt hyperextend their neck

Question 17

What happens if after gentle rotation and angling the tubing, you are still met with more that slight resistance?

Answer 17

• Never force the tube forward b/c it can cause serious damage of the nasal mucosa
• Instead, remove the the tube and re-lubricate the end of the tube and attempt insertion in the opposite naris

Question 18

When the pt begins to gag, then the NG tube is currently located in the _____. What do you do?

Answer 18

nasopharynx. Stop advancing the tube and instead withdraw about 1/8 inch to stop the gagging and instruct the pt to flex their head forward towards their chest and drink a sip of water and swallow.

Question 19

When the pt flexes their head forward, when should you advance the NG tube?

Answer 19

Each time they swallow– help cue the pt to swallow.

Question 20

If the pt continues to gag and cough, what may have happened to the tube? What do you do?

Answer 20

It may have curled up in the back of the throat. Stop the procedure immediately if the pt exhibits symptoms of respiratory distress or cyanosis.

Question 21

Once the NG tube is placed inside of the pt, what do you do next?

Answer 21

Tape the tubing to the pt’s nose– making sure to avoid positioning the tube where it is against the naris

Question 22

When collecting the aspirate from the pt’s stomach after NG tube insertion, it is important to note the _____ and check the _____.

Answer 22

color; pH

Question 23

While waiting for the NG tube placement to be verified by x-ray, can you instill anything into the tubing? Including a normal saline, water, meds, and formula?

Answer 23

No. Nothing should be instilled in the NG tube because the NG tube could be placed in the lungs and aspiration can result.

Question 24

Why is blowing into the stomach not primarily used to confirm placement after an NG tube is placed?

Answer 24

The sound generated by the auscultation and blowing air into the stomach through the NG tube is very similar to the gurgling sound sheard in the lungs

Question 25

Why is the aspiration of stomach contents and checking the pH of it not used to primarily confirm confirmed placement after a NG tube is placed?

Answer 25

Although the color of the stomach contents are usually green or tan in color and respiratory secretions are normally clear, the pH of both are too similar to differentiate correct placement

Question 26

What types of pts would have NG tubes?

Answer 26

• W/ nutritional problems
• Need extra calories
• Bleeding stomach ulcers
• Bowel obstructions
• Unable to take meds orally