NG tubes and feeding Flashcards by Joseph Cuda

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

examples of gastrointestinal tubes

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

How well did you know this?

Not at all

Perfectly

Can all medications be crushed or altered ?

NO!

How well did you know this?

Not at all

Perfectly

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

Long acting and slow release drugs cannot be crushed

How well did you know this?

Not at all

Perfectly

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 well did you know this?

Not at all

Perfectly

How much water should be mixed with the crushed pills ?

15-30 ml

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

NG tube goes through the ______________ and into the ____________

nose; stomach

How well did you know this?

Not at all

Perfectly

a nasointestinal tube goes through the ___________ and into the ________________

nose; duodenum

How well did you know this?

Not at all

Perfectly

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

aspiration

How well did you know this?

Not at all

Perfectly

Can suctioning be used with NG tubes?

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

How well did you know this?

Not at all

Perfectly

Why is excessive suction harmful?

It can cause mucosal damage

How well did you know this?

Not at all

Perfectly

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

High Fowlers position

How well did you know this?

Not at all

Perfectly

Measure distance: NG tube insertion

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

How well did you know this?

Not at all

Perfectly

NEX

nostril - earlobe - xiphoid process

For NG tube measurement purposes

How well did you know this?

Not at all

Perfectly

what size of NG tube is common ?

Size 16

How well did you know this?

Not at all

Perfectly

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

8-12 inches

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

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

Study These Flashcards

lubricate; lift

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

Study These Flashcards

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

NG tubes and feeding Flashcards

(57 cards)