44TH CASE SCENARIO NGT PLACEMENT. NURSING.(NASOGASTRIC TUBE)

Ngt is the placement of a flexible 14 – 18inches French plastic tube from the nose into the stomach. It can be placed in right or left nare. If the patient has facial or nasal trauma, ngt should be inserted orally.The ng tubes are use when swallowing is compromised.For example Patient fails swallow evaluation.

PROCEDURES:

(1)Gather supplies : 14- 18inches flexible French nasogastric tube.

Gloves.

60syringe french Catheter tip.

2% Xylocaine lubricant.

Adhesive tape.

Cup of Ice chips or water.

Emesis basin.

Portable suction with tubing and yankauer tip.

(2)Sit the patient up in flexed upright position.

(3)Explain procedure to patient. The risk and benefits of ngt.

(4) Put on your gloves and eye goggle.

(5) Measure the tube from the tip of nose to the Xyphoid process or tip of breast nipples.Know how many centimeters. It is usually 50cm to 60cm for most people. Mark your measurements.

(6)Check and examine the nose to make sure that there is no obstruction.

(7)Apply Xylocaine 2% 5- 10cm to tip of nasal.

(8)Turn on the suction .

(9)Place cup of ice or water and emesis basin close to patient.

(10)Remove the cap of nasal gastric tube and lubricate the first 6inches of the tube.

(11)With patient head flexed,place the ngt to the unobstructed nostril.

(12) Check placement by attaching the catheter tip syringe and aspirate.You aspirate for gastric content. Also chest Xray to make sure that the tube is in the right position.

Questions:

(1) The doctor orders a nasogastric tube inserted and connected to low intermittent suction for patient with an intestinal obstruction. Two hours after the insertion of the nasogastric tube. The patient vomits 200ml into an emesis basin. What is the first action that the nurse should take?.

Answer: Irrigate the nasogastric tube.Tube is obstructed. Use only normal saline for irrigation (Isotonic)Water is hypotonic solution.

(2 )An 88years old woman is admitted to the hospital from a nursing home.She refuses to eat food and removes her nasogastric tube each time that it is inserted. Total Parental nutrition(TPN)is ordered. Initially patient is to receive 1000ml of TPN in 24hours.The intravenous set delivers 15drops per milliliter. The nurse should regulate the flow so that it can deliver how many drops of per minute.

Correct answer: 10 drop per minutes.

( 3)The nurse cares for a patient with bowel obstruction .A nasogastric tube is to be inserted. Before the insertion of the nasogastric tube, the nurse should explain the purpose of the nasogastric tube to the patient. Which of the following statement if made by the nurse, is most appropriate

Answer:

(A)It is inserted to empty fluid from the stomach .Used to decompress your stomach, gastric immobility, and gastric content removal.

(B)Your doctor is like that.He like to do this to his patients.

(C )It is also use for feeding tube and medications.

( D)All of the above is correct.

Correct answer A.

(4) What is the size of the nasogastric tube?.

(A)Size depends on what your patient want.

(B)14 to 18 inches flexed French nasogastric tube.

(C )Size doesn’t matter at all.

(D) All of the above.

Correct answer B.

( 5)Why is it important to check for placement after insertion of nasogastric tube.

(A) To make sure that the nasogastric tube is in the stomach. ( The right place)

(B ) To follow the doctor orders.

(C ) To check for nasal obstruction.

(D) All of the above.

Correct answer A.

Nursing Consideration.

Perform oral care for your patient.

Apply lubricant to lips.

Provide support.

Empty canisters 2/3 full.

(6 )Mr James Nutmeg is a 77 years old man with CVA left side weaker than the right side.Failed swallow evaluation.Slightly facial drooping left side .Follows simple commands. Can pull self up.

MRSA of sputum.

Cardiac : Left chest pacemaker. ( Occasionally pacing)

Restraint bilateral upper Extremity.

Diet Strict NPO :Ngt to right nare.Glucerna 1.5 at 60ml/hour ,flush with 30ml of water Q6hours.

Lungs : Coarse

Suction prn.

Neurological:Alert and oriented ×1.

Confused

GU/GI Incontinent bowel and bladder.

Skin : Intact.

Blood sugar Q6hours.

MRI on hold due to pacemaker.

PLAN:

NPO after midnight the night before. ( ngt feeding on hold)

Peg tube placement in two days.

Plavix on hold for 7 days.

Restraint to be renewed in 24hours.

(7)Why is this patient NPO?.

(8)Why is patient on restraint?.

(9)Why is plavix on hold for seven days?.(10) Is patient really confused or language barrier issue?.

Published by edochie99

A Registered Nurse with over twenty years of hospital experience, an author with Masters Degree in Nursing,also Bachelor Degree in Nursing,graduated in 1996 from USC,University of Southern California.MSN in 2009 University of Phoenix.

Leave a comment

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this: