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Nasogastric Tube
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
• 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 30-
60 mins.
• Continuous feeding - administered via infusion pump. Feedings are generally
infused over 24 hours at rates ranging from 50-150ml
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:
• 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)
NURSING CONSIDERATIONS:
1. Prepare equipments.
6. Keep the tube from hanging dependent below the level of entrance to the drainage
bottle.
11. Document
NURSING DIAGNOSIS:
2. Impaired swallowing
4. Diarrhea
7. Acute Pain
• 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:
CLINICAL SIGNS
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
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
Child: Fr 12-18
CONTRAINDICATIONS:
• Rectal/anal surgery
• Bowel obstruction
• Inflammatory/infection of the abdomen
TYPES OF ENEMAS
• Infant: 50-150ml
• Toddler: 250-350ml
• Child: 300-500ml
• Adolescent: 500-700ml
• Adult: 750-1000ml
NURSING DIAGNOSIS
• Constipation
• Risk for Fluid Volume Deficit
• Situational Low Self Esteem
RECALL INSTILLATIONS
1. Secure consent.
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.
• Chemical Irritants
• Stool Lubricants
• Stool softeners
• Bulk formers
• Osmotic agents