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*N126-U4-I. NG*

Dobrisky-U4-Nasogastric Intubation

QuestionAnswer
Name the 4 purposes for nasogastric tubes enteral feedings, decompression, lavage, compression
name the type of tubes used for enteral feedings duo, dobhoff, levin
to instill liquid feedings & meds for a patient who can't swallow without aspirating or can't eat by mouth which kind of tube is needed? enteral feeding tube
for the removal of secretions & gaseous substances from the GI tract or relief of abdominal distention which type of tube is used? decompression
what are the names of common decompression tubes? salem sump, levin, miller-abbott
A dobhoff is what type of tube? enteral feeding tube
a Levin is what type of tube? decompression, enteral feedings or lavage
the tube used for irrigation of the stomach in cases of active bleeding or poisoning is lavage
an Ewald is what type of tube? lavage
for internal application of pressure by means of inflated balloon to prevent internal esophageal or GI hemorrhage what type of tube is used? compression
name a compression tube sengstaken-blakemore
a miller-abbot is what type of tube? decompression
a salem sump is what kind of tube? decompression or lavage
which tube is used for "gastric gavage"? enteral feeding tube
in case of poisoning which type of tube would be used? lavage
which type of tube uses a ballon to preven hemorrhage? compression
describe how to determine the length needed for a nasogastric tube? measure ear to tip of nose to xyphoid process
what is the best way to check placement of a nasogastric tube? xray
large bore tubes are how big in diameter? >12 French
large bore tubes are used most for what? suctioning/decompression
a large bore levin tube can be used for what? suctioning or feeding
this large bore tube is flexible, rubber or plastic, single lumen tube with holes near the tip levin tube
this tube is not common due to the large size and the irritation it causes to the mucousa levin tube
a salem sump-double lumen tube is used for decompression
the salem sump-double lumen tube has a smaller lumen and a larger lumen
the smaller lumen of the salem sump is what color? blue
what is the blue end used for? air
can you put feedings through a salem sump? no
the blue lumen is open to air to allow for what? equalization of pressure
equalization of pressure will help avoid what? irritation of gastric mucosa
the larger lumen of a sale sump is used for what? it drains gastric contents
the air vent should be positioned where? above the patient's midline
the drainage receptacle should be positioned where? below the patient's midline
what type of valve is used on salem sumps? anti-reflux valve
the blue end of the anti-reflux valve fits into which port of the salem sump tube? the blue air port
what suction pressure is used mostly for levin tubes? 80-100mm Hg
what is the range for low suction pressure 80-100mm Hg
what is considered high suction pressure 100-120mm Hg
which type of suction is used to protect the mucus membrane lining near the tip of the suction tube? intermittent suction
small bore tubes are pliable and used for? feeding purposes and medication administration
small bore tubes have what tool to help pass the tube into the stomach? a stylet
describe the stylet of a small bore tube it is hollow to allow air to be injected thru it to check for placement
when is a stylet removed? when placement has been confirmed
some feeding tubes are weighted with what to promote passage of the tube into the small intestine? tungstun
nasoenteric feedings are used for short term nutritional support
how long is short term nutritional support 6 weeks or less
prolonged intubation of a nasoenteric feeding tube could cause what complications? sinusitis, erosion of the nasal septum or esophagus or distal esophageal strictures
what are three ways tube feedings are administered? bolus amount via gravity, intermittently gravity drip or continuous drip by infusion pump
how often are tube feedings administered by a bolus several times per day
what type of syringe is used for bolus feedings? large bore syringe
for what reasons should a weighted tube be used? when the stomach must be bypassed due to injury or disease or when the patient's condition prohibits elevation of the head
describe the process of advance a tube into the duodenum position the patient on right side, allow gravity to assist passage of the tube through the pyloric sphincter
how long may it take for a tube to pass through the pyloric sphi9ncter on its own? up to 24 hours
what does AAA of ng tube placement verification mean? assess, air, aspirate
when do you assess, air and aspirate? while waiting for xray
what is the best way to confirm placement of an ng tube? xray
when assessing for placement you should inspect, auscultate and palpate the abdomen for abnormalities
what should you inspect in addition to the abdomen when checking placement? back of mouth for coiled tube
"air" is the 2nd verification...how does it work? inject 30 mls of air into the tube via syringe
when injecting air what is the most important thing a nurse should know? the reason for the tube, air may be harmful to the patient
what size syringe should be used when injecting air into an ng tube? 60ml syringe
what is the purpose of injecting air? helps return of aspirate by flushing out formula, medications or flush solutions
aspirate is pulling back a small amount (10-15ml) of gastric contents to check for ph and to observe it's color and consistency.
gastric tube aspirate should have a pH of 5.5 or less
a gastric tube aspirate ph of 6 or more indicates misplacement into the respiratory tract
during insertion of an ng tube what position should the patient be in? fowlers with chin down
in order to obtain accurate pH results no meds, feedings with in last hour, no antacids or acid inhibitors
if a patient has gastric reflux, pernicious anemia or visceral neuropathy will a pH reading of gastric juices be accurate? no
what do you do before laying a patient flat that is receiving feedings? turn off the feeding
what is the key to feeding tube clogs? prevention
flushing should be done immediately before & after feedings
flushing before & after feedings should be done with how much fluid? 30 mls
what type of fluid is used to flush a feeding tube? tap water
can meds be mixed with tube feeding? not unless ordered by the MD
how much water should be used to flush the tube between medications? atleast 5mls
if giving six medications when should you flush? before and after each medication
if the tube is clogged what can you have the patient do to help clear it? reposition the patient
if the tube is clogged how do you flush? don't force, gently & firmly push and ppull the plunger back and forth
after pushing warm water in to a tube that is clogged what do you do? clamp and wait a few minutes to allow the water to "soak"
medications for flushing the tube must be ordered by an MD (if not listed as a PRN med)
name a few clog buster medications Viokase powder, Clog Zapper CORPAK, Bard PEG cleaning Brush, Bionix DeCloggers
how often should gastric residual be checked before each feeding or every 4-6 hours during continous feedings
when should continuous feedings be checked for residual? every 4-6 hours (depends on institution)
what complication is assessed for when checking gastric residual? delayed gastric emptying
to check residual what type of syringe is used? 60ml
what should be known by the nurse before returning aspirate to the stomach? what the dr has ordered as acceptable residual amounts
if the order states to return if under 200mls what do you do with excess? call the dr to report the excess and to receive instruction on what to do with excess
after aspirating and returning stomach contents what should be done next flush the tube with 30mls of water
do you flush with water if you return aspirate? yes always
aspirate should be placed in a graduate and measured before being returned to the stomach
a patient receiving tube feedings should be elevated at least 30 degrees
what must you plan for when before placing a patient flat? stop feeding 30-60 minutes before to prevent aspiration
to prevent rupturing the tube you should always use a 30-60ml syringe
what type of care should always be given for a patient with a tube in place? frequent nose and mouth care
what type of fluid do you use to irrigate an ng tube used for decompression? normal saline
why is normal saline used to irrigate an ng tube used for decompression? to prevent alteration of the sodium balance
if an ng tube is used for feedings what type of fluid is used to irrigate? warm tap water
when should sterile water be used to irrigate a feeding tube? when a patient is critically ill or immunocompromised
how often should placement of a tube be assessed? at the beginning of each shift and before flushing, feeding or administering meds
what is the first step you should take when assessing at the beginning of your shift? turn off the pump/suction in order to auscultate the abdomen
besides the abdomen what else should be checked? the nares for irritation
a salem sump tube should be flushed with saline to avoid what condition? hypokalemia
Created by: Lori Dobrisky