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Naso gastric 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 down to the nasopharynx & into the alimentary tract

Providing Enteral Fedings

Bolus feeding - 300-500 ml of formula are delivered 4-6 times a day delivered via syringe over 10-15 mins Intermittent feeding - formula is placed into gravity bag and dripped in over 3060 mins. Continuous feeding - administered via infusion pump. Feedings are generally infused over 24 hours at rates ranging from 50-150ml

NURSING ASSESSMENT OF CLIENTS RECEIVING TUBE FEEDINGS

1. Check bowel sounds prior to each feeding 2. Check for correct placement of tube before feeding Measure abdominal girth when

there is abdominal distention 3. Determine allergies 4. Check for pH (Acidic-stomach; Alkalinic=respiratory tract/intestinal tract 5. Presence of regurgitation and feeling of fullness after feeding

NURSING ASSESSMENT OF CLIENTS RECEIVING TUBE FEEDINGS:

6. Dumping syndrome 7. Diarrhea, constipation, flatulence 8. Urine for sugar and acetone 9. Hematocrit & urine specific gravity 10. Serum BUN & Sodium levels

NURSING CONSIDERATIONS:
***Secure consent 1. Assess reason for the tube and patient's understanding of the needs for NGT. 2. Explain the procedure. 3. Measure 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. Mark with a piece of tape. 4. Obtain assistance if the client is confused or disoriented 5. Do not place plastic tubes in ice become they will become stiff & inflexible. Rubber tubes can be placed in ice for 10-15 mins.

NURSING CONSIDERATIONS
6. Elevate the head of bed before feeding & leave it up for 30-60 mins after feeding (risk for aspiration) 7. Check if the tube is intact every 4 hours according to institution policy. 8. Frequently assess the nostrils for discharge & irritation. 9. If a disposable bag is used, rate of flow should be regulated as ordered. 10. If a syringe method is used, care should be taken to allow as little air as possible

to enter the stomach.

NGT PROCEDURE:
1. Lubricate the first 4 inches of the tube with water-soluble lubricant (KY jelly) 2. Ask the client to slightly flex the neck backward (for easy insertion) 3. Tip head forward once once tube reaches nasopharynx (esophagus instead of trachea) 4. Advance the tube as client swallows water or ice chips until the taped mark is reached.

NGT REMOVAL:
1. Assess client prior to removal of NGT

Ask for flatus (+) gas Gastric decompression Monitor for gastric bleeding: make sure the tube is not draining large amount of secretions (no blood) - indicates poor gastric emptying, paralytic ileus, obstruction

2. To remove, flush tube with 10-22cc of NSS, inject 10cc of air. 3. Pull the tube in 3-6 seconds

GASTROSTOMY/JEJUNOSTOMY Indicated for long-term enteral feeding 6-8 weeks May be placed endoscopically, surgically (most common), or radiologically Percutaneous Endoscopic gastrostomy (PEG)/Percutaneous Endoscopic Jejunostomy (PEJ) PEG (Percutaneous Endoscopic Gastrostomy)

= placement of a feeding tube directly into the stomach enteral nutrition - economical - no general anesthesia - less risky because no surgery

GASTRIC LAVAGE (NASOGASTRIC IRRIGATION)

NURSING CONSIDERATIONS:
1. Prepare equipments. 2. Explain the procedure. 3. Place on a semi-fowler's position. 4. Provide freedom of movement. 5. Check if the tubing is kinked. 6. Keep the tube from hanging dependent below the level of entrance to the drainage bottle. 7. Note the amount & kind of solution used. 8. NOte the color, amount & consistency of drainage. 9. Note the patient's reaction to the procedure. 10. Perform oral care every 2 hours. 11. Document

NURSING DIAGNOSIS:
1. Imbalanced Nutrition: Less than body requirements 2. Impaired swallowing 3. Risk for Aspiration 4. Diarrhea 5. Impaired Oral Mucous Membrane

6. Risk for Deficient Fluid Volume 7. Acute Pain 8. Impaired Skin Integrity

GASTROINTESTINAL ELIMINATION FACTORS THAT HINDERS NORMAL GIT ELIMINATION Accumulation of flatus, fluids or feces caused by slowing or stopping of peristalsis (paralytic ileus, stomach CA) Surgical bypass procedures such as colostomy Head or spinal injury Immobility (constipation) Change in the diet Change in usual bowel elimination Pregnancy Drugs (ferrous sulfate) ALTERATIONS ON THE CHARACTERISTIC OF THE STOOL:

1. Alcholic stool = gray, pale, clay colored 2. Hematochezia = bright red blood 3. Melena = black, tarry stools 4. Steatorrhea = greasy, bulky, foul-smelling

CLINICAL SIGNS

Decreased bowel sounds upon ausculation Distention of the intestine or flatulence Abdominal pain Vomiting Diarrhea Constipation Fecal Impaction

INDEPENDENT NURSING ACTIONS

1. Position the client correctly on a toilet or bedpan. 2. Assist when the client feels the urge to defecate. 3. Help the client select foods that contain bulk. 4. Increase fluid intake & encourage exercise. 5. Provide privacy.

DEPENDENT NURSING ACTIONS

1. Suctioning the stomach via NGT lavage. 2. Inserting a rectal tube. 3. Caring for a colostomy 4. Administering enema. 5. Inserting a suppository.

Procedures involving the GIT require medical and not surgical asepsis becasue the GIT is NOT sterile.

ADMINISTERING ENEMA
ENEMA = a solution introduce into the rectum and sigmoid colon for the purpose of removing feces and/or flatus

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

3. To soften & remove fecal impaction 4. To wash out waste products when the bowel is to be examined for certain diagnostic procedures/or childbirth.

NURSING CONSIDERATIONS:
1. Check doctor's order for the type of enema, amount, & frequency 2. Position: LEFT LATERAL with hips slightly elevated with right leg flexed. Place a child or a client with poor sphincter control on a padded bedpan in a dorsal recumbent position. 3. Temperature: not too hot or not too cold but just right 4. Size of rectal catheter: Adult: Fr 23-30 (laki naman!) Child: Fr 12-18 5. Height: 12-18 inches

CONTRAINDICATIONS:

Rectal/anal surgery Bowel obstruction Inflammatory/infection of the abdomen

TYPES OF ENEMAS
1. CLEANSING ENEMA = To cleanse the bowel in preparation for diagnostic test or surgery 2. CARMINATIVE ENEMA = To relieve gas

3. OIL RETENTION ENEMA = To soften the stool/relieve constipation or fecal impaction 4. RETURN FLOW ENEMA (Harris Flush or Colonic Irrigation) = To facilitate flatulence

AMOUNT OF ENEMA SOLUTION:

Infant: 50-150ml Toddler: 250-350ml Child: 300-500ml Adolescent: 500-700ml Adult: 750-1000ml

SIZES OF ENEMA TUBE

Adult: Fr 22-32 catheter Children: Fr 14-18 Infant: Fr 12 (or bulb syringe)

NURSING DIAGNOSIS

Constipation Risk for Fluid Volume Deficit Situational Low Self Esteem

RECALL INSTILLATIONS ADVANTAGES OF RECTAL SUPPOSITORIES:

1. Avoids irritation of the upper GIT 2. Some medications may have objectionable taste 3. Drug is released at a slow and steady rate 4. Provides higher blood stream levels of medications

ENEMA PROCEDURE:
1. Secure consent. 2. Provide privacy, & position in left lateral sims. 3. Fill enema container with appropriate amount of solution of lukewarm (tepid) temp. (105-110F) 4. Open clamp on tubing to allow solution to flow (& remove air that causes discomfort), thenn clamp 5. Lubricate catheter & ask patient to take slow deep breath as rectal tube is inserted gently (3-4 inches in adult, no more than 4 inches) 6. Open clamp to allow solutions to flow slowly from container at maximum 18 inches height 7. If resistance is felt, encourage client to take dep breaths, & run small amount of solution. NEVER FORCE! (ayyy)

ENEMA PROCEDURE:
8. Remove tube (when desired amount is infused) & squeeze buttocks together firmly. 9. Encourage client to hol solution as long as possible (5-10 mins for cleansing enema, 30 mins for retention enema) 10. Then assist in evacuating the bowel. Repeat, if ordered "until clear" but allow time to rest. 11. For small volume enema, squeeze bottle to empty content (about 240 ml) into rectum. 12. Contraindicated for suspected appendicitis (increases abdominal pressure), abdominal pain, nausea and vomiting.

LAXATIVES

Chemical Irritants Stool Lubricants Stool softeners Bulk formers Osmotic agents