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COLLEGE OF NURSING
Cagayan de Oro City, Philippines
VISION
STATEMENT Teaching-Learning Guide: N 107.2 & N 108.1 Enhancements
To be a
leading ASEAN Topic Assisting in NGT insertion
University
forming leaders Entry Competencies:
of character by Prior to the discussion, the student shall have acquired knowledge, skills & attitude in the care of clients across the lifespan with NGT insertion.
2033.
Time N 107.2 & N 108.1 (Classroom Guide)
Frame
MISSION
Teaching-Learning References Evaluation
STATEMENT
Week Learning Outcomes Content Activities
Xavier Univer- (Time allotment)
sity (Ateneo de
Cagayan) 1 Given a hypothetical or actual scenario or NGT insertion (2 hrs) First Rotation
forms men and situation related to the care of clients on I.A Definition – Kozier & Erb's 10-30pt quiz
women of assisting NGT insertion, the students will be Inserted through one of the nostrils, down the Student Input: Fundamentals
competence,
conscience and
able to: nasopharynx, and into the alimentary tract of Nursing Paper & pen tests
commitment in Lecture-Discussion
service of the a. Recite the definition and identify Purposes: Ppt presentation Perrie & Enhancement
church, the indications and purposes of To administer tube feedings and Video show Potter’s Rubrics
Global inserting nasogastric tube. medications to clients unable to eat Demonstration & Clinical
community and b. Cite materials and equipments by mouth or swallow a sufficient diet Return Nursing Skills
the Filipino needed for NGT insertion. without aspirating food or fluids into Demonstration and
people. c. Utilize the process of Assessment, the lungs etc Techniques
Diagnosis, Planning, Nursing To establish a means for suctioning
Considerations, Implementation stomach contents to prevent gastric
and Evaluation on doing the distention, nausea, and vomiting
procedure. To remove stomach contents for
d. Demonstrate & return demonstrate laboratory analysis
the proper procedure with To lavage (wash) the stomach in
rationale. case of poisoning or overdose of
medications
Orig COURSE OUTLINE Template Prepared by XUCAT. Revised with permission by MGM P May 2011. TLG N 107.2 & N 108.1 1
Xavier University - Ateneo de Cagayan
COLLEGE OF NURSING
Cagayan de Oro City, Philippines
I.C Assessment:
-Please refer to Appendix 1 table
>Diagnosis:
Imbalanced Nutrition: Less than body
requirements
Readiness for Enhanced Nutrition
Risk for aspiration
Orig COURSE OUTLINE Template Prepared by XUCAT. Revised with permission by MGM P May 2011. TLG N 107.2 & N 108.1 2
Xavier University - Ateneo de Cagayan
COLLEGE OF NURSING
Cagayan de Oro City, Philippines
>Planning:
- Please refer to Appendix 2 table
Orig COURSE OUTLINE Template Prepared by XUCAT. Revised with permission by MGM P May 2011. TLG N 107.2 & N 108.1 3
Xavier University - Ateneo de Cagayan
COLLEGE OF NURSING
Cagayan de Oro City, Philippines
>Implementation
Preparation
Assist the client to a high-Fowler’s
position if his or her health condition
permits, and support the head on a
pillow. Rationale: It is often easier to
swallow in this position and gravity
helps the passage of the tube.
Place a towel or disposable pad across
the chest.
Performance
1. Introduce self and verify the client’s
identity using agency protocol.
Explain to the client what you are
going to do, why it is necessary, and
how he or she can participate.
Establish a method for the client to
indicate distress and a desire for you
to pause the insertion such as raising
a finger or hand.
2. Perform hand hygiene and observe
other appropriate infection prevention
procedures (e.g., clean gloves).
3. Provide for client privacy.
4. Assess the client’s nares.
Apply clean gloves. Ask the client to
hyperextend the head, and, using a
flashlight, observe the intactness of
the tissues of the nostrils, including
any irritations or abrasions.
Examine the nares for any obstructions
or deformities by asking the client to
breathe through one nostril while
occluding the other.
Orig COURSE OUTLINE Template Prepared by XUCAT. Revised with permission by MGM P May 2011. TLG N 107.2 & N 108.1 4
Xavier University - Ateneo de Cagayan
COLLEGE OF NURSING
Cagayan de Oro City, Philippines
Orig COURSE OUTLINE Template Prepared by XUCAT. Revised with permission by MGM P May 2011. TLG N 107.2 & N 108.1 6
Xavier University - Ateneo de Cagayan
COLLEGE OF NURSING
Cagayan de Oro City, Philippines
Orig COURSE OUTLINE Template Prepared by XUCAT. Revised with permission by MGM P May 2011. TLG N 107.2 & N 108.1 7
Xavier University - Ateneo de Cagayan
COLLEGE OF NURSING
Cagayan de Oro City, Philippines
Orig COURSE OUTLINE Template Prepared by XUCAT. Revised with permission by MGM P May 2011. TLG N 107.2 & N 108.1 8
Xavier University - Ateneo de Cagayan
COLLEGE OF NURSING
Cagayan de Oro City, Philippines
Evaluation:
- Please refer to Appendix 3 table
Prepared Angeles, Beannca & Ferrer Merielle Supervising Clinical Instructor: Pinque, Mildred, RN,MN
Level IV Students Level IV Clinical Instructor
MECHANICS:
1. BSN4 SNs to prepare TLG for the assigned topics; one TLG per topic
2. CIs to supervise the enhancement
2.1. collect the completed TLGs from BSN4 SNs
2.2. facilitate the SNs presentations during the enhancement sessions
2.3. grade the presentations using rubric
2.4. tests the SNs through paper and pen test/quiz (10-30 items per week);
3. Focus on issues, concerns and innovations related to the topics considered;
4. Case presentations per group to be facilitated during enhancement session (per agreed time by CI and SNs MT period);
5. Q&A Drills’ topics to align with CA2 calendar;
5.1. Each SN to prepare test items (1-10) with rationale and shares these with the group
5.2. Teaching-learning activities may vary in the drill: ppt presentation, games, etc
6. completed TLGs should be submitted to the supervising CI week prior to scheduled presentation;
7. For other concerns, please approach CI-in-charged or the level coordinator.
Appendix 1:
ASSESSMENT:
Step Rationale
1. Verify health care provider’s order for type of tube and enteric Health care provider’s order is needed to intubate patient with feeding
feeding schedule. tube.
Orig COURSE OUTLINE Template Prepared by XUCAT. Revised with permission by MGM P May 2011. TLG N 107.2 & N 108.1 10
Xavier University - Ateneo de Cagayan
COLLEGE OF NURSING
Cagayan de Oro City, Philippines
2. Assess patient’s knowledge of procedure. Encourages cooperation, reduces anxiety, and minimizes risks.
Identifies teaching needs.
3. Have patient close each nostril alternately and breathe. Examine Sometimes nares are obstructed or irritated, or a septal defect or facial
each naris for patency and skin breakdown. fractures are present. Place tube in most patent nostril.
4. Review patient’s medical history (e.g., for basilar skull fracture, History of these problems may require you to consult with health care
nasal problems, nosebleeds, facial trauma, nasal-facial surgery, provider to change route of nutritional support. Passage of tube
deviated septum, anticoagulant therapy, coagulopathy). intracranially can cause neurologic injury.
5. Assess patient’s mental status (ability to cooperate with These are risk factors for inadvertent tube placement into
procedure, sedation), presence of cough and gag reflex, ability to tracheobronchial tree (Krenitsky, 2011).
swallow, critical illness, and presence of an artificial airway.
6. Perform physical assessment of abdomen. Absent bowel sounds, abdominal pain, tenderness, or distention may
indicate medical problem contraindicating feedings.
Appendix 2:
PLANNING:
Step Rationale
1. Expected outcomes following completion of procedure:
- Tube is verified as placed in stomach or intestine. - Correct technique ensures placement in intended location (Bourgault
- Feeding tube remains patent. and Halm, 2009).
- Patient has no respiratory distress (e.g., increased respiratory - Proper irrigation clears tube of formula residue (Bankhead et al.,
rate, coughing, poor color) or signs of discomfort or nasal 2009).
trauma. Correctly placed tube causes no interference with airway - Correctly placed tube causes no interference with airway
2. Explain procedure to patient, including sensations that will be Increases patient’s cooperation with intubation procedure and helps
felt during insertion. lessen anxiety
3. Explain to patient how to communicate during intubation by Patient must have way of communicating to alleviate stress and enhance
raising index finger to indicate gagging or discomfort. cooperation
Appendix 3.
EVALUATION:
Step Rationale
Orig COURSE OUTLINE Template Prepared by XUCAT. Revised with permission by MGM P May 2011. TLG N 107.2 & N 108.1 11
Xavier University - Ateneo de Cagayan
COLLEGE OF NURSING
Cagayan de Oro City, Philippines
1. Observe patient’s response to intubation. Have patient speak. Abnormal lung sounds may indicate aspiration. Assists with confirmation
Check vital signs. Option: You may use capnography in critical of tube placement.
care settings to determine if tip of tube is in trachea or lung.
2. Confirm x-ray results with health care provider Verifies position of tube before initiating enteral feeding
3. Remove the stylet (if used) after x-ray film verification of correct If placement needs adjustment, stylet is still in place.
placement.
4. Routinely check location of external exit site marking on the tube Routine evaluation ensures correct placement of tube and reduces the risk
and color and pH of fluid aspirated from tube. of aspiration.
5. After removal, assess patient’s level of comfort. Provides for continued comfort of the patient
Orig COURSE OUTLINE Template Prepared by XUCAT. Revised with permission by MGM P May 2011. TLG N 107.2 & N 108.1 12