Bernales, Jan Lianne E.

NCM 116a Medical-Surgical Nursing RLE

BSN III-B2 Module #2 Activity #1
 Nasogastric
Intubation

Nursing
Interventions: Outcomes/
PRE-OP
Indications:
Evaluation:
*Provide oral and skin
*Gastric care. Give mouth rinses and
apply lubricant to the
decompression, patient’s lips and nostril.
including maintenance *Verify NG tube placement. *Improvement in
of a decompressed state Wear gloves. nutrition.
after endotracheal *Face and eye protection.
intubation, often via *Be more
INTRA comfortable
the oropharynx.
*Briefly explain the
*Relief of symptoms procedure to the client and *Have less pain
and bowel rest in the assess their capability to
*Fewer problems
setting of small-bowel participate.
obstruction *Position client upright or in eating
full Fowler’s position if *Have greater
*Aspiration of gastric possible.
content from recent *Measure tubing from bridge
independence
ingestion of toxic of nose to earlobe, then to *Not to feel
material the point halfway between
hungry/thirsty 6
the end of the sternum and
*Administration of the navel. *Better quality of
medication *Instruct the client to
swallow as the tube
life
*Feeding advances. *Decreased risk of
*Bowel irrigation *If changes occur in pneumonia
*NG tube can be kept patient’s respiratory status, if
following corrosive tube coils in mouth, if the *Live longer
patient begins to cough or
ingestion for the turns cyanotic, withdraw the *Enjoy food
development of a tract tube immediately.
in the esophagus that POST-OP
*Have more freedom
subsequently can be *Patients equipped with the *Health to be better
used for balloon NG tube must maintain good
dilatation. oral hygiene and the need to *Fewer coughing
clean their nose regularly. episodes
The healthcare team is also
entitled to check for any *Fewer choking
irregularities such as signs of
irritation, infection, or episodes
ulceration while the NG tube
is in place.
Aside from administering
drugs and other oral agents,
an NG tube is widely used to
carry food to the stomach
through the nose. It can be
used for all feedings or for
giving a person extra
calories.
 Potential Nursing Interventions Client Education
Complications
Infection l Observe proper hand l Encourage patient of
washing and don non- doing oral hygiene
sterile gloves. Clean, not regularly.
sterile, technique is l Hand washing and
necessary because the observing other practices
gastrointestinal (GI) tract that decreases the risk of
is not sterile. infection.
l Use a new feeding bag l The tapes used to keep the
daily or as instructed by NG tube in place may
your healthcare team. need to be changed
Between feedings, rinse regularly. This may be
the bag thoroughly with done every day. The tape
warm water. also needs to be changed
l Use a new syringe each if it gets wet or dirty.
day. If you use syringes l Report any symptoms of
for medication only, rinse fever like increase on
with warm water and temperature, chills and
replace every other day or etc.
as instructed by your
healthcare team.
l For commercially-
prepared formula, pour
the amount into the bag
that will be used within
12 hours.
l When preparing
powdered formula, follow
mixing instructions from
your healthcare
professional or on the
formula label carefully.
l Practice good oral
hygiene. Keeping your
mouth clean and moist
may help prevent oral
bacteria from migrating
down the airway and
causing pneumonia.
l Refrigerate leftover
formula and discard after
24 hours.
l Ask your healthcare
professional if you should
 use purified or sterile
water for tube feeding.
Aspiration l Positioning- Elevating the l Position client upright or
head of the bed is a very in full Fowler’s position if
effective method for possible. Place a clean
preventing aspiration. towel over the client’s
Lying flat or with the chest. Full Fowler’s
head slightly elevated position assists the client
increases the possibility to swallow, for optimal
of aspirating, especially neck-stomach alignment
so if a patient has an and promotes peristalsis.
absent or weak gag reflex
or is receiving feedings
by a nasogastric tube.
l Oral Care- Entry of oral,
nasal, and gastric
secretions into the lungs
cause aspiration
pneumonia. Rigorous
attention to oral care and
possibly the use of
antiseptic mouth rinses
that contain chlorhexidine
are often used as ways to
reduce the number of
microorganisms in the
oral cavity and prevent
aspiration.
l Measuring Residual
Gastric Volume- If the
residual is above a certain
amount then it is assumed
that the patient’s
gastrointestinal tract is not
properly absorbing the
liquid nutrition and the
excess volume puts the
patient at risk for
aspirating.
l Avoid sedating drugs-
The use of sedating drugs
increases the risk of
aspiration. Administering
these medications is a
nursing responsibility
Wrong l Measure tubing from l Briefly explain the
bridge of nose to earlobe, procedure to the client
placement then to the point halfway and assess his capability
between the end of the to participate. It is not
sternum and the navel. advisable to explain the
Mark this spot with a procedure too far in
small piece of temporary advance because the
tape or note the distance. client’s anxiety about the
Each client will have a procedure may interfere
slightly different terminal with its success. It is
insertion point. important that the client
l Flex the client’s head relax, swallow, and
forward, tilt the tip of the cooperate during the
nose upward and pass the procedure.
tube gently into the nose l Instruct the client to
to as far as the back of the swallow as the tube
throat. Guide the tube advances. Advance the
straight back. Flexing the tube until the correct
head aids in the anatomic marked position on the
insertion of the tube. The tube is reached.
tube is less likely to pass Encourage the client to
into the trachea. breathe through his
l If changes occur in mouth. Swallowing of
patient’s respiratory small sips of water may
status, if tube coils in enhance passage of tube
mouth, if the patient into the stomach rather
begins to cough or turns than the trachea.
cyanotic, withdraw the
tube immediately. The
tube may be in the
trachea.
l If obstruction is felt, pull
out the tube and try the
other nostril. The client’s
nostril may deflect the
NG into an inappropriate
position. Let the client
rest a moment and retry
on the other side.
l Check the back of the
client’s throat to make
sure that the tube is not
curled in the back of the
throat.
l Check tube placement
with these methods:
 o Aspirate stomach
contents
o Check pH of
aspirated contents.
o Inject air into
stomach while
auscultating.
o Confirm by Xray.
l Secure the tube with tape
or commercially prepared
tube holder once stomach
placement has been
confirmed.

Reference:

Shlamovitz, G. Z. (2020, April 21). Nasogastric Intubation: Background, Indications,

Contraindications. Medscapes. https://emedicine.medscape.com/article/80925-
overview#a2

Williams, E. (1954, May 5). Nursing Care of the Patient with Cirrhosis of the Liver. JSTOR.
https://www.jstor.org/stable/3460795?seq=1

Nasogastric Intubation. (n.d.). Drugs.Com. https://www.drugs.com/cg/nasogastric-intubation-

aftercare-
instructions.html#:%7E:text=NG%20tube%20care%3A,is%20pinned%20on%20your%2
0clothes.

Wayne, G. B. (2018, December 29). Nasogastric Intubation. Nurseslabs.

https://nurseslabs.com/nasogastric-intubation/

Carrera, L. M. A. S. (2019, September 7). How to Prevent Infection Related to Tube Feeding.
Shield HealthCare.
http://www.shieldhealthcare.com/community/nutrition/2015/01/28/how-to-prevent-
infection-related-to-tube-feeding/