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Nasogastric Tube
Purpose of NGT Feeding
1. Administer tube feedings & medication clients unable to eat by mouth 2. To establish means of Suctioning or to flush stomach 3. To remove gastric contents for diagnosis of peptic ulcer & or Decompression

WAYS TO CHECK FOR PROPER NGT PLACEMENT GASTRIC GAVAGE

Small intestine tube feedings! " instillation of specially prepared nutrients into the digestive tract through a tube that is inserted through one of the nostrils do#n to the nasopharynx & into the alimentary tract

Providing Enteral Fedings

$olus feeding % 3&&%'&& ml of formula are delivered (%) times a day delivered via syringe over 1&%1' mins *ntermittent feeding % formula is placed into gravity bag and dripped in over 3&% )& mins. +ontinuous feeding % administered via infusion pump. ,eedings are generally infused over 2( hours at rates ranging from '&%1'&ml

NURSING ASSESSMENT OF CLIENTS RECEI ING TU!E FEE"INGS

1. +hec- bo#el sounds prior to each feeding 2. +hec- for correct placement of tube before feeding .easure abdominal girth #hen

there is abdominal distention 3. Determine allergies (. +hec- for p/ Acidic%stomach0 Al-alinic"respiratory tract1intestinal tract '. 2resence of regurgitation and feeling of fullness after feeding

NURSING ASSESSMENT OF CLIENTS RECEI ING TU!E FEE"INGS#

). Dumping syndrome 3. Diarrhea4 constipation4 flatulence 5. 6rine for sugar and acetone 7. /ematocrit & urine specific gravity 1&. Serum $68 & Sodium levels

NURSING CONSI"ERATIONS#
999Secure consent 1. Assess reason for the tube and patient:s understanding of the needs for 8;T. 2. <xplain the procedure. 3. .easure the insertion length by placing the tube:s tip on the client:s nose & extending it to the tip of the earlobe & then to the xiphoid process of the sternum. .ar- #ith a piece of tape. (. =btain assistance if the client is confused or disoriented '. Do not place plastic tubes in ice become they #ill become stiff & inflexible. >ubber tubes can be placed in ice for 1&%1' mins.

NURSING CONSI"ERATIONS
). <levate the head of bed before feeding & leave it up for 3&%)& mins after feeding ris- for aspiration! 3. +hec- if the tube is intact every ( hours according to institution policy. 5. ,re?uently assess the nostrils for discharge & irritation. 7. *f a disposable bag is used4 rate of flo# should be regulated as ordered. 1&. *f a syringe method is used4 care should be ta-en to allo# as little air as possible

to enter the stomach.

NGT PROCE"URE#
1. @ubricate the first ( inches of the tube #ith #ater%soluble lubricant AB Celly! 2. As- the client to slightly flex the nec- bac-#ard for easy insertion! 3. Tip head for#ard once once tube reaches nasopharynx esophagus instead of trachea! (. Advance the tube as client s#allo#s #ater or ice chips until the taped mar- is reached.

NGT REMO AL#

1. Assess client prior to removal of 8;T

As- for flatus D! gas ;astric decompression .onitor for gastric bleedingE ma-e sure the tube is not draining large amount of secretions no blood! % indicates poor gastric emptying4 paralytic ileus4 obstruction

2. To remove4 flush tube #ith 1&%22cc of 8SS4 inCect 1&cc of air. 3. 2ull the tube in 3%) seconds

;AST>=ST=.B1F<F68=ST=.B *ndicated for long%term enteral feeding )%5 #ee-s .ay be placed endoscopically4 surgically most common!4 or radiologically 2ercutaneous <ndoscopic gastrostomy 2<;!12ercutaneous <ndoscopic FeCunostomy 2<F! 2<; 2ercutaneous <ndoscopic ;astrostomy!

" placement of a feeding tube directly into the stomach enteral nutrition % economical % no general anesthesia % less ris-y because no surgery

;AST>*+ @AGA;< 8AS=;AST>*+ *>>*;AT*=8!

NURSING CONSI"ERATIONS#
1. 2repare e?uipments. 2. <xplain the procedure. 3. 2lace on a semi%fo#ler:s position. (. 2rovide freedom of movement. '. +hec- if the tubing is -in-ed. ). Aeep the tube from hanging dependent belo# the level of entrance to the drainage bottle. 3. 8ote the amount & -ind of solution used. 5. 8=te the color4 amount & consistency of drainage. 7. 8ote the patient:s reaction to the procedure. 1&. 2erform oral care every 2 hours. 11. Document

NURSING "IAGNOSIS#
1. *mbalanced 8utritionE @ess than body re?uirements 2. *mpaired s#allo#ing 3. >is- for Aspiration (. Diarrhea '. *mpaired =ral .ucous .embrane

). >is- for Deficient ,luid Golume 3. Acute 2ain 5. *mpaired S-in *ntegrity

;AST>=*8T<ST*8A@ <@*.*8AT*=8 ,A+T=>S T/AT /*8D<>S 8=>.A@ ;*T <@*.*8AT*=8 Accumulation of flatus4 fluids or feces caused by slo#ing or stopping of peristalsis paralytic ileus4 stomach +A! Surgical bypass procedures such as colostomy /ead or spinal inCury *mmobility constipation! +hange in the diet +hange in usual bo#el elimination 2regnancy Drugs ferrous sulfate! A@T<>AT*=8S =8 T/< +/A>A+T<>*ST*+ =, T/< ST==@E

1. Alcholic stool " gray4 pale4 clay colored 2. /ematocheHia " bright red blood 3. .elena " blac-4 tarry stools (. Steatorrhea " greasy4 bul-y4 foul%smelling

CLINICAL SIGNS

Decreased bo#el sounds upon ausculation Distention of the intestine or flatulence Abdominal pain Gomiting Diarrhea +onstipation ,ecal *mpaction

INDEPENDENT NURSING ACTIONS

1. 2osition the client correctly on a toilet or bedpan. 2. Assist #hen the client feels the urge to defecate. 3. /elp the client select foods that contain bul-. (. *ncrease fluid inta-e & encourage exercise. '. 2rovide privacy.

"EPEN"ENT NURSING ACTIONS

1. Suctioning the stomach via 8;T lavage. 2. *nserting a rectal tube. 3. +aring for a colostomy (. Administering enema. '. *nserting a suppository.

2rocedures involving the ;*T re?uire medical and not surgical asepsis becasue the ;*T is 8=T sterile.

A"MINISTERING ENEMA
<8<.A " a solution introduce into the rectum and sigmoid colon for the purpose of removing feces and1or flatus

PURPOSES OF ENEMA
1. To stimulate peristalsis & urge to defecate. 2. To relieve constipation

3. To soften & remove fecal impaction (. To #ash out #aste products #hen the bo#el is to be examined for certain diagnostic procedures1or childbirth.

NURSING CONSI"ERATIONS#
1. +hec- doctor:s order for the type of enema4 amount4 & fre?uency 2. 2ositionE @<,T @AT<>A@ #ith hips slightly elevated #ith right leg flexed. 2lace a child or a client #ith poor sphincter control on a padded bedpan in a dorsal recumbent position. 3. TemperatureE not too hot or not too cold but Cust right (. SiHe of rectal catheterE AdultE ,r 23%3& la-i namanI! +hildE ,r 12%15 '. /eightE 12%15 inches

CONTRAINDICATIONS:

>ectal1anal surgery $o#el obstruction *nflammatory1infection of the abdomen

TYPES OF ENE AS
1. +@<A8S*8; <8<.A " To cleanse the bo#el in preparation for diagnostic test or surgery 2. +A>.*8AT*G< <8<.A " To relieve gas

3. =*@ ><T<8T*=8 <8<.A " To soften the stool1relieve constipation or fecal impaction (. ><T6>8 ,@=J <8<.A /arris ,lush or +olonic *rrigation! " To facilitate flatulence

A OUNT OF ENE A SOLUTION:

*nfantE '&%1'&ml ToddlerE 2'&%3'&ml +hildE 3&&%'&&ml AdolescentE '&&%3&&ml AdultE 3'&%1&&&ml

SI!ES OF ENE A TU"E

AdultE ,r 22%32 catheter +hildrenE ,r 1(%15 *nfantE ,r 12 or bulb syringe!

NURSING DIAGNOSIS

+onstipation >is- for ,luid Golume Deficit Situational @o# Self <steem

RECALL INSTILLATIONS ADVANTAGES OF RECTAL SUPPOSITORIES:

1. Avoids irritation of the upper ;*T 2. Some medications may have obCectionable taste 3. Drug is released at a slo# and steady rate (. 2rovides higher blood stream levels of medications

ENEMA PROCE"URE#
1. Secure consent. 2. 2rovide privacy4 & position in left lateral sims. 3. ,ill enema container #ith appropriate amount of solution of lu-e#arm tepid! temp. 1&'%11&,! (. =pen clamp on tubing to allo# solution to flo# & remove air that causes discomfort!4 thenn clamp '. @ubricate catheter & as- patient to ta-e slo# deep breath as rectal tube is inserted gently 3%( inches in adult4 no more than ( inches! ). =pen clamp to allo# solutions to flo# slo#ly from container at maximum 15 inches height 3. *f resistance is felt4 encourage client to ta-e dep breaths4 & run small amount of solution. 8<G<> ,=>+<I ayyy!

ENEMA PROCE"URE#
5. >emove tube #hen desired amount is infused! & s?ueeHe buttoc-s together firmly. 7. <ncourage client to hol solution as long as possible '%1& mins for cleansing enema4 3& mins for retention enema! 1&. Then assist in evacuating the bo#el. >epeat4 if ordered Kuntil clearK but allo# time to rest. 11. ,or small volume enema4 s?ueeHe bottle to empty content about 2(& ml! into rectum. 12. +ontraindicated for suspected appendicitis increases abdominal pressure!4 abdominal pain4 nausea and vomiting.

LA#ATIVES

+hemical *rritants Stool @ubricants Stool softeners $ul- formers =smotic agents