TEST 3 - Nasogastric Tubes Flashcards
Indications for a NG tube:
Decompress the stomach Keep stomach empty until normal peristalsis returns Examples: Post-op after major surgery Bowel obstructions Sometimes used for enteral feedings For medication administration
Single lumen tube with holes near the tip
Used to drain stomach secretions
Levin tube
Has two lumina
Removal of gastric contents
Provide an air vent
Used to remove gastric content
Salem sump
Softer smaller bore tube
Feeding tubes
What is the traditional method for measuring a NG tube accurately?
Measure distance from tip of nose to earlobe to xiphoid process
Hanson method
First mark 50 cm point on tube then do traditional measurement
Insertion should be to midway point btw 50 cm and traditional mark
Nursing Considerations when inserting an NG tube
Lubrication Head tilted back slightly initially Chin to chest once past nasopharynx Swallow water Give a break between attempts If client vomits, must clear airway first before continuing Verifying tube placement Ask client to talk Inspect posterior pharynx for coiled tube Aspirate gently back for gastric contents Measure pH of aspirate (< 4) X-rays Proper anchoring Securing tube to nose and to gown Set suction as ordered
How many ml’s is added for Irrigating NG Tubes
Draw up 30 ml of NS in a 50-60 cc catheter-tip syringe
When D/c order has been issued
Explain and reassure client Turn off suction Disconnect connecting tubing Remove securing tape and safety pin Hand client facial tissue Place towel or blue pad on client’s chest Insert 20 ml of air into lumen of NG tube Remove steadily and smoothly Measure amt of drainage Note character of content Clean nares, provide mouth care Explain diet plans Dispose of equipment according to agency’s policy
What are some complications with NG tubes
Abdominal distention
Sore throat
Skin breakdown
Pulmonary aspiration
True or False
Medications can be administered into NG tubes that are inserted for decompression
False
Tablets are acceptable except:
Enteric coated (i.e. ECASA, Arthrotec, Ferrous sulphate)
Sustained release (i.e. zyban, wellbutrin SR)
Chewable tablets
Lozenges
Buccal and sublingual
Bulk forming laxatives
Teratogenic, carcinogenic, or cytotoxic drugs
Medication Administration via NG Tube
If giving tablets:
Must be well crushed
Dissolved thoroughly in water
NG tube must be irrigated well before, between and after medication(s)
Medication Administration via NG Tube
If giving capsules:
Speak with pharmacist to √ if it is o.k. to express
Dissolve each capsule’s contents separately by:
Opening the capsule and empty contents into 30 ml of water
Piercing the capsule with a needle, draw contents into 30 ml of tepid water
Gelcaps can also be dissolved in warm water
Medication Administration via NG Tube
When administering medication the client should be in what position?
Position in high Fowler’s if permitted
◦high-fowlers or semi-fowlers position
◦”back and forth”
◦Head tilted back slightly initially
◦Chin to chest once past nasopharynx
Medication Administration via NG Tube
When administering medication what should be checked prior to administration?
Check for gastric residual
If > than 200 ml, return aspirate to client, withhold meds, → indicates delayed gastric emptying, notify physician
Medication Administration via NG Tube
Irrigate with?
Irrigate with 30 ml of tepid water
Administer first dose of dissolved medication
Flush with 15-30 ml of water in between medications
Follow last dose with 30-60 ml of water
Medication Administration via NG Tube
If continuous tube feeding
If continuous tube feeding
Stop feeding x 1 hour to allow absorption
Keep HOB elevated x 1 hour to ↓ risk of aspiration
Medication Administration via NG Tube
If meds require an empty stomach
If meds require an empty stomach, stop enteral feeding x 30 min before and after med admin.
Medication Administration via NG Tube
what must you never do?
Never crush or dissolve tablets or capsules together.
Oral and Nasopharyngeal suctioning
Indications for suctioning
Promote an open or patent airway
Done when noninvasive technique is not enough
Adjunct Medications
Antibiotics Bronchodilators Steroids Decongestants Antihistamines Expectorants
What are some possible causes for obstructions?
Mucus
Mechanical obstruction (tongue)
Foreign body
Oropharyngeal Suctioning
S & S indicating need for suctioning:
Gurgling on inspiration or expiration Restlessness Obvious excess oral secretions Drooling Gastric secretions or vomitus in mouth Coughing without clearing secretions from upper airway
Vacuum Pressure Settings for Suctioning
Preterm infants 60-80 mm Hg Infants 80-100 mm Hg Children 100-120 mm Hg Adults 100-150 mm Hg
Signs of Hypoxia
Hypoxemia (↓ O2 tension in the blood) Hypercapnia (↑ CO2 tension in the blood) Apprehension Anxiety Audible lung sounds ↓ LOC ↑ fatigue and dizziness Behavioural changes (irritability, restlessness) ↑ pulse rate ↑ rate of breathing ↑BP ↓ depth of breathing Cardiac dysrhythmias Pallor Cyanosis Dyspnea Use of accessory muscles for breathing
Nursing Considerations with Nasogastric Tubes
•Check nasal passage for:
◦air intake
◦fractures
◦obstructions
Nursing Considerations with Nasogastric Tubes
•Check abdomen for:
◦auscultate for bowel sounds
◦palpate for masses
Nursing Considerations with Nasogastric Tubes
•Check LOC
◦dementia
◦restless - need help from someone to hold the client
Nursing Considerations with Nasogastric Tubes
Lubrication
◦water soluble
◦lubricate the tip
•Attach 60 cc syringe at end of tube to avoid stomach contents spilling on patient
Nursing Considerations with Nasogastric Tubes
Diet After Discontinuation
•clear fluids to soft foods, gradually increase diet as tolerated
List non-invasive techniques that are helpful in maintaining a patent airway
- Hydration
- Positioning
- Nutrition
- Chest therapy airway clearance techniques
- Mucous clearance device therapy
- Deep breathing
- Coughing
- Humidity
- Aerosol therapy
What are the signs and symptoms that would indicate the need for suctioning?
S & S indicating need for suctioning:
- Gurgling on inspiration or expiration
- Restlessness
- Obvious excess oral secretions
- Drooling
- Gastric secretions or vomitus in mouth
- Coughing without clearing secretions from upper airway
A patient’s wife asks why that “funny looking bag” was attached to her husband’s breathing tube and squeezed before he was suctioned. Which response by the nurse is most appropriate?
A) “This gives him extra oxygen before his tube is suctioned.”
B) “This maneuver compensates for the anticipated suction-induced hypercarbia.”
C) “What are your concerns regarding the procedure?”
D) “It helps prevent the lungs from collapsing while he is being suctioned.”
A) “This gives him extra oxygen before his tube is suctioned.”
The nurse is preparing to perform nasopharyngeal suction on a patient. Which assessment is most important for the nurse to do before beginning the procedure?
A) Whether the patient has been sick within the past 3 months
B) Whether the patient has ever had the procedure done before
C) Whether the patient has any environmental allergies such as allergies to dust or grasses
D) Whether the patient has an allergy to shellfish
C) Whether the patient has any environmental allergies such as allergies to dust or grasses
A patient has a nasogastric tube after abdominal surgery. Which action by the nurse maintains the patency of the air vent?
A) Irrigating the blue pigtail with 10 mL of air
B) Keeping the blue pigtail above the patient’s stomach
C) Irrigating the blue pigtail with 10 to 20 mL of normal saline
D) Verifying that the patient’s abdomen is not distended
A) Irrigating the blue pigtail with 10 mL of air
The nurse is preparing to verify the placement of a patient’s nasogastric tube. Which method of placement verification by the nurse would best indicate that the end of the tube is in the stomach?
A) Checking the pH of the aspirated gastric contents
B) Auscultating the stomach while air is injected into the nasogastric tube
C) Listening for the return of the patient’s bowel sounds
D) Obtaining gastric fluid in the tube when aspirating with a syringe
A) Checking the pH of the aspirated gastric contents
The best method is to check the pH of the aspirated gastric contents to ensure that gastric contents are in the tube. Gastric aspirates usually have a pH of 4 or less
