TEST 3 - Nasogastric Tubes

Question 1

Indications for a NG tube:

Answer 1

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

Question 2

Single lumen tube with holes near the tip

Used to drain stomach secretions

Answer 2

Levin tube

Question 3

Has two lumina
Removal of gastric contents
Provide an air vent
Used to remove gastric content

Answer 3

Salem sump

Question 4

Softer smaller bore tube

Answer 4

Feeding tubes

Question 5

What is the traditional method for measuring a NG tube accurately?

Answer 5

Measure distance from tip of nose to earlobe to xiphoid process

Question 6

Hanson method

Answer 6

First mark 50 cm point on tube then do traditional measurement
Insertion should be to midway point btw 50 cm and traditional mark

Question 7

Nursing Considerations when inserting an NG tube

Answer 7

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

Question 8

How many ml’s is added for Irrigating NG Tubes

Answer 8

Draw up 30 ml of NS in a 50-60 cc catheter-tip syringe

Question 9

When D/c order has been issued

Answer 9

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

Question 10

What are some complications with NG tubes

Answer 10

Abdominal distention
Sore throat
Skin breakdown
Pulmonary aspiration

Question 11

True or False

Medications can be administered into NG tubes that are inserted for decompression

Answer 11

False

Question 12

Tablets are acceptable except:

Answer 12

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

Question 13

Medication Administration via NG Tube

If giving tablets:

Answer 13

Must be well crushed
Dissolved thoroughly in water
NG tube must be irrigated well before, between and after medication(s)

Question 14

Medication Administration via NG Tube

If giving capsules:

Answer 14

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

Question 15

Medication Administration via NG Tube

When administering medication the client should be in what position?

Answer 15

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

Question 16

Medication Administration via NG Tube

When administering medication what should be checked prior to administration?

Answer 16

Check for gastric residual

If > than 200 ml, return aspirate to client, withhold meds, → indicates delayed gastric emptying, notify physician

Question 17

Medication Administration via NG Tube

Irrigate with?

Answer 17

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

Question 18

Medication Administration via NG Tube

If continuous tube feeding

Answer 18

If continuous tube feeding
Stop feeding x 1 hour to allow absorption
Keep HOB elevated x 1 hour to ↓ risk of aspiration

Question 19

Medication Administration via NG Tube

If meds require an empty stomach

Answer 19

If meds require an empty stomach, stop enteral feeding x 30 min before and after med admin.

Question 20

Medication Administration via NG Tube

what must you never do?

Answer 20

Never crush or dissolve tablets or capsules together.

Question 21

Oral and Nasopharyngeal suctioning

Indications for suctioning

Answer 21

Promote an open or patent airway

Done when noninvasive technique is not enough

Question 22

Adjunct Medications

Answer 22

Antibiotics
Bronchodilators
Steroids
Decongestants
Antihistamines
Expectorants

Question 23

What are some possible causes for obstructions?

Answer 23

Mucus
Mechanical obstruction (tongue)
Foreign body

Question 24

Oropharyngeal Suctioning

S & S indicating need for suctioning:

Answer 24

Gurgling on inspiration or expiration
Restlessness
Obvious excess oral secretions
Drooling
Gastric secretions or vomitus in mouth
Coughing without clearing secretions from upper airway

Question 25

Vacuum Pressure Settings for Suctioning

Answer 25

``` Preterm infants 60-80 mm Hg Infants 80-100 mm Hg Children 100-120 mm Hg Adults 100-150 mm Hg ```

Question 26

Signs of Hypoxia

Answer 26

``` 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 ```

Question 27

Nursing Considerations with Nasogastric Tubes | •Check nasal passage for:

Answer 27

◦air intake ◦fractures ◦obstructions

Question 28

Nursing Considerations with Nasogastric Tubes | •Check abdomen for:

Answer 28

◦auscultate for bowel sounds | ◦palpate for masses

Question 29

Nursing Considerations with Nasogastric Tubes •Check LOC

Answer 29

◦dementia | ◦restless - need help from someone to hold the client

Question 30

Nursing Considerations with Nasogastric Tubes Lubrication

Answer 30

◦water soluble ◦lubricate the tip •Attach 60 cc syringe at end of tube to avoid stomach contents spilling on patient

Question 31

Nursing Considerations with Nasogastric Tubes Diet After Discontinuation

Answer 31

•clear fluids to soft foods, gradually increase diet as tolerated

Question 32

List non-invasive techniques that are helpful in maintaining a patent airway

Answer 32

* Hydration * Positioning * Nutrition * Chest therapy airway clearance techniques * Mucous clearance device therapy * Deep breathing * Coughing * Humidity * Aerosol therapy

Question 33

What are the signs and symptoms that would indicate the need for suctioning? S & S indicating need for suctioning:

Answer 33

* Gurgling on inspiration or expiration * Restlessness * Obvious excess oral secretions * Drooling * Gastric secretions or vomitus in mouth * Coughing without clearing secretions from upper airway

Question 34

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."

Answer 34

A) "This gives him extra oxygen before his tube is suctioned."

Question 35

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

Answer 35

C) Whether the patient has any environmental allergies such as allergies to dust or grasses

Question 36

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

Answer 36

A) Irrigating the blue pigtail with 10 mL of air

Question 37

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

Answer 37

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