FON (therapeutic care) BSc(N)

1. Care of patient with
Pain.

23. Care of patient with
Naso-gastric tube

24. Naso-gastric suction:
• Nasogastric (NG) intubation is a procedure in which a thin,
plastic tube is inserted into the nostril, toward the esophagus,
and down into the stomach.
• NG tubes are usually short and are used mostly for suctioning
stomach contents and secretions.
• here are various tubes used in GI intubation but the following
two are the most common:
• Levin tube. Is a single-lumen multipurpose plastic tube that is
commonly used in NG intubation.
• Salem sump tube. A double-lumen tube with a “pigtail” used
for intermittent or continuous suction.

26. Nursing Management:
The following are the nursing considerations you should watch out for:
• Provide oral and skin care. Give mouth rinses and apply lubricant to
the patient’s lips and nostril. Using a water-soluble lubricant,
lubricate the catheter until where it touches the nostrils because the
client’s nose may become irritated and dry.
• Verify NG tube placement. Always verify if the NG tube placed is in
the stomach by aspirating a small amount of stomach contents. An
X-ray study is the best way to verify placement.
• Wear gloves. Gloves must always be worn while starting an NG
because potential contact with the patient’s blood or body fluids
increases especially with inexperienced operator.
• Face and eye protection. On the other hand, face and eye
protection may also be considered if the risk for vomiting is
high. Trauma protocol calls for all team members to wear gloves,
face and eye protection and gowns.

27. Naso-gastric Irrigation:
• A nasogastric tube is irrigated regularly to determine and
ensure the tube’s patency. It will help release any formula
stuck to the inside of the tube.
• Objective
To ensure the patency of the nasogastric tube.
• Indication
Stomach contents fail to flow through tube.

28. Steps in Irrigating Nasogastric
Tubes
• The following is the step-by-step procedure in irrigating
nasogastric tubes:
1 Check physician’s order for irrigation. Explain procedure to
client. Clarifies schedule and irrigating solution. An explanation
encourages client cooperation and reduces apprehension.
2 Gather necessary equipment. Check expiration dates on
irrigating saline and irrigation set. Provides for organized
approached to task. Agency policy dictates safe interval for
reuse of equipment.
3 Wash your hands. Handwashing deters the spread of
microorganisms.
4 Assist client to semi-Fowler’s position unless this is
contraindicated. Minimizes risk of aspiration.

29. Cont…
5 Check placement of NG tube using the following techniques:
A. Attach Asepto or Toomey syringe to the end of tube and
aspirate gastric contents. The tube is in the stomach if its contents can
be aspirated.
B. Place 10mL-50ml of air in syringe and inject into the tube.
Simultaneously, auscultate over the epigastric area with a
stethoscope. A whooshing sound can be heard when the air enters the
stomach through the tube.
C. Ask client to speak. If tube is misplaced in trachea, client will not
be able to speak.
6 Clamp suction tubing near connection site. Disconnect NG tube
from suction apparatus and lay on disposable pad or towel. Protects
client from leakage of NG drainage.
7 Pour irrigating solution into container. Draw up 30 ml of saline (or
amount ordered by physician) into syringe. Delivers measured
amount of irrigant through NG tube. Saline compensates for
electrolytes lost through NG drainage.

30. Cont…
8 Place tip of syringe in NG tube. Hold syringe upright and gently
insert the irrigant (or allow solution to flow in by gravity if agency or
physician indicates). Do not force solution into NG tube. Position of
syringe prevents entry of air into stomach. Gentle insertion of saline
(or gravity insertion) is less traumatic to gastric mucosa.
9 If unable to irrigate tube, reposition client and attempt irrigation
again. Check with physician if repeated attempts to irrigate tube
fail. Tube may be positioned against gastric mucosa making it difficult
to irrigate.
10 Withdraw or aspirate fluid into syringe. If no return, inject 20 ml
of air and aspirate again. Injection of air may reposition the end of
tube.
11 Reconnect NG tube to suction. Observe movement of solution or
drainage. Determine patency of NG tube and correct operation of
suction apparatus.

31. Cont…
12 Measure and record amount and description of irrigant and
return solution. Irrigant placed in NG tube is considered intake:
solution returned is recorded as output.
13 Rinse equipment if it will be reused. Promotes cleanliness
and prepares equipment for next irrigation.
14 Wash your hands. Handwashing deters the spread of
microorganisms.
15 Record irrigation procedure, description of drainage and
client’s response. Facilitates documentation of procedure and
provides for comprehensive care.

32. GASTRIC ANALYSIS
General Examination of gastric contents and gastric juice
provides information used in diagnosis. For example, the
following may be determined:
(1) The presence, amount, or absence of hydrochloric acid.
(2) The presence of cancer cells.
(3) The types and amounts of enzymes present.

33. Pre-Procedural Nursing
Implications.
(1) The patient must be educated about the procedure, the
significance of the preparation, and any significant post-procedural
sequelae.
(2) Many procedures require that the patient sign a permit. Check with
your local MTF SOP.
(3) The physician may require the patient to be nothing by mouth
(NPO) for 8-10 hours prior to the test.
(4) Gastric analysis requires the insertion of a gastric tube for the
purpose of withdrawing a specimen. General care and precautions
associated with gastric intubation should be implemented. (Refer to
Section IV, Gastrointestinal Intubation.)
(5) If ordered by the physician, withdraw the stomach contents and
save for lab analysis.
(6) The patient should be allowed to rest for 20 to 30 minutes after
insertion of the tube before beginning the test. This allows time for the
patient’s body to return to a rested, basal state.

34. Procedural Nursing
Implications.
(1) Obtain the specimens as directed by the physician or local
SOP.
(2) Label each specimen with the amount and the time collected
in addition to the patient identification.
(3) Note and report the presence of the following:
• Undigested food.
• Blood.
• Fecal odor.
(4) Assess the patient’s tolerance to the procedure by
monitoring blood pressure and pulse.
(5) Some gastric analysis tests require the administration of
drugs to stimulate gastric secretion. It is necessary to have an
emergency cart available in these cases.

35. Post-Procedural Nursing
Implications.
(1) Monitor the patient’s vital signs in accordance with the
ward’s SOP.
(2) Observe for signs of throat irritation secondary to tube
placement.
(3) Observe for signs of bleeding from the throat or stomach.
(4) Resume diet and medication IAW the physician’s orders or
ward SOP.