UNIVERSITY OF CAGAYAN VALLEY

College of Health
College Avenue, Tuguegarao City,3500
Main Campus: Dr. Matias P. Perez Sr. Bldg
Phone Fax # (078) 844 8981

GIVING AN INTERMITTENT FEEDING VIA A NASOGASTRIC TUBE

 Enteral feeding is a procedure whereby prescribed liquid formula is instilled directly into
the stomach or small intestine using a feeding tube.

A. Learning Objectives
Students will:
o Administer enteral feeds via nasogastric tube (NGT).

B. Equipment
o Feeding tray
o Kidney basin
o Syringes-50 ml, 10/20 ml
o Ph indicator or litmus paper
o Prescribed feed
o Protective sheet
o Jug with cool boiled water
o Feeding schedule
o I/O chart
o Stethoscope

C. Procedure
EVIDENCE TO BE PRODUCED RATIONALE
1. Check physician’s order for type,
amount and frequency or feeding.
2. Swab unopened formula into Reduces the spread of microorganisms.
container top with alcohol.
(Commercially prepared formula)
3. Pour prescribed amount of formula If refrigerated, warm formula by placing
into container container in hot water, do not use
microwave to warm formula.
4. Date and refrigerate opened Discard the formula after 24 hours.
formula.
5. Wash hands or apply hand rubs. Reduces spread of microorganisms.
6. Check client’s identification band To recognize the patient.
and have client state his/her name.
Introduce self to the client.
7. Provide privacy and explain
procedure and purpose to the client.
8. Assess client’s abdomen to verify Absence of bowel sounds indicates reduced
presence of bowel sounds peristalsis.
9. Check mark on tube at the exit site Ensures that there is no migration of tube.
10. Don gloves.
11. Elevate client’s head of bed 30-45
degree angle or high fowlers.
12. Place towel under work area.
13. Insert syringe into NG tube to
validate gastric placement A “whoosh” sound will be heard if tube is
a. Auscultate “whoosh” of in the stomach.
injected air.
b. Check color and test ph of A Ph below 4 indicates tube is in stomach.
aspirate (once every 8 hours Litmus paper will turn from blue to red.
after first 24 hours of tube Feeding should be withheld if residual
placement) volume is greater than 1/2/ the amount of
c. Aspirate gastric contents to previously delivered feeding.
determine residual volume.
d. Return aspirated contents to
stomach.
14. Pre flush prior to feeding if
necessary.
15. Pinch tubing. Prevents air from entering the stomach.
16. Remove plunger from barrel of
syringe, and attach barrel to NG
tube.
17. Fill syringe with formula (If using
feeding bag, adjust drip rate to
infuse over 30 minutes. Usually
drop factor on feeding bags is 20
drops/ml.
18. Hold container no more than 18
inches above client’s stomach.
19. Allow formula to infuse slowly
(between 20 and 35 minutes)
through the tubing. Clamp tubing or
continue to fill syringe before
syringe empties, do not allow
syringe to “run dry”.
20. Follow tube feeding with water Keeps tube patent.
flush in amount ordered (usually 30-
60 ml)
21. Reinsert anti reflux valve
22. Maintain head of bed elevation at
least 1-2 hours.
23. Return equipment to client’s
bedside.
24. Give prescribed amount of water
between feedings, PO or per tube, if
tube feeding is sole source of
nutrition
25. Provide oral hygiene. Promotes comfort and reduces risk of roal
infection/ulcer.
26. Remove gloves and wash hands Reduces transmission of microorganisms
27. Determine client’s comfort level
28. Identify unexpected outcomes and
intervene as necessary
29. Record and report intervention and
client’s response.
 UNIVERSITY OF CAGAYAN VALLEY
College of Health
College Avenue, Tuguegarao City,3500
Main Campus: Dr. Matias P. Perez Sr. Bldg
Phone Fax # (078) 844 8981

NASOGASTRIC TUBE REMOVAL

 Remove tube as soon as patient can tolerate orally to minimize complication.

A. Learning Objectives
Students will:
o Determine if the patient can tolerate feeding.

B. Equipment
o Tissues
o Plastic Disposable bag
o Bath towel or disposable pad
o Clean disposable glove

C. Procedure
EVIDENCE TO BE PRODUCED RATIONALE
1. Check physician’s order for the Ensures correct implementation of
removal of the nasogastric tube physician’s order.
2. Wash hands. Reduces transmission of microorganisms.
3. Prepare the materials needed for the Provides organized approach to task.
procedure
4. Check client’s identification band
and have client state his/her name.
Introduce self to the client.
5. Provide privacy and explain Facilitate cooperation.
procedure and purpose to the client.
6. Provide the patient 45-90 degrees or
sit patient upright for optimal neck
and stomach alignment.
7. Don gloves. Reduces transmission of microorganisms.
8. Check for the placement of the tube
by injecting a bolus of air and
auscultate for the “whoosh” sound
9. Administer at least 30 ml of water
for flushing and inject a bolus of air.
10. Instruct the client to do deep Prevents accidental aspiration of any gastric
 breathing while you gently remove secretions in tube.
the tube.
11. Discard the materials used. Proper disposal deters spread
microorganisms.
12. Perform oral hygiene Provides comfort
13. Remove gloves and wash hands Reduces transmission of microorganisms.
14. Determine client’s comfort level
15. Identify unexpected outcomes and
intervene as necessary
16. Record and report intervention and Measuring nasogastric drainage provides
client’s response. for accurate recording of output.
 UNIVERSITY OF CAGAYAN VALLEY
College of Health
College Avenue, Tuguegarao City,3500
Main Campus: Dr. Matias P. Perez Sr. Bldg
Phone Fax # (078) 844 8981

COLOSTOMY CARE

 Colostomy is a surgical procedure that brings the end of the large intestine through the
abdominal wall. Stools moving through the intestine drain into a bag attached to the
abdomen.
 The procedure is usually done after bowel resections or injuries and it may be temporary
or permanent.

A. Learning Objectives
Students will:
o Explain difference in color and consistency of drainage based on the location of a
bowel diversion
o Perform correct ostomy care including removal of drainage bag, assessment of
stoma, stoma care, and replacement of new drainage bag.

B. Equipment
o Colostomy irrigation kit
o Gauze 4x4 or stoma cover
o Tape if gauze is used
o Clean gloves
o Ostomy odor eliminator
o Bedpan, toilet, or basin

C. Procedure

EVIDENCE TO BE PRODUCED RATIONALE

1. Check doctor’s orders: note any
new orders
2. Identifies the correct patient.
3. Inspects the stoma and the
surrounding skin.
4. Assesses patient’s understanding on
the colostomy bag.
5. Prepared the environment. Provide
Ensures that the correct procedure is carried
out on the correct patient
To assess the skin integrity around the
stoma
Gains cooperation and allays anxiety
 privacy.
6. Washes hands and gather requisites Prevent transmission of microorganisms.
7. Measure the dimensions of the Ensures the wafer is the correct size. Proper
stoma prior to obtaining an ostomy planning will save time.
appliance system.
8. Prior to change of the colostomy Ensures a clean environment and to protect
bag, don gloves and place the health care personnel.
protective sheet.
9. Empty the drainage from the current Prevents contamination of the surrounding
ostomy appliance into a clean environment if stool accidentally leaks from
plastic bag. Remember to measure the appliance.
the output.
10. Removes the soiled appliance by Prevents skin peeling and reduces pain for
gently peeling away from the skin the patient.
(from the top); support surrounding
skin with the other hand.
11. Disposes of appliance in appropriate Infection control.
waste container.
12. Removes gloves and wash hands. Reduces transmission of microorganisms.
13. With clean gloves wash stoma and
skin with warm tap water; ensure
the surrounding skin is clean.
14. Pats dry with a clean dry towel.
15. Measure stoma using a measuring Correct measurement ensures a good fit of
guide for appropriate length and the ostomy appliance without excess skin at
width. the base of the stoma exposed to the stool.
16. Places gauze pad over orifice of Prevents leakage of stool during the
stoma before preparing the wafer preparation of the wafer.
and pouch for application.
17. Traces the pattern with a pencil/pen.Inaccurate pattern size causes laceration of
Cut wafer as traced. Smoothen the the stoma or maceration of peristomal skin
cut edges. from constant with stool.
18. Attaches clean pouch to wafer. Pre attaching the pouch to the wafer prevent
Ensure that it is all locked around stool from leaking underneath the wafer
the flange. during application and avoids
contamination.
19. Removes the gauze from the orifice Allows better visualization of the stoma.
of the stoma
20. Applies stomahesive paste evenly Enhances adherence to the skin.
around the stoma opening on the
back of the wafer.
21. Removes the protective backing
paper from the back of the wafer,
22. Places on skin with stoma centred in Stabilizes the wafer and prevents the edges
the cut out opening of wafer. of the wafer from sticking onto the
patient’s clothing.
23. Presses the wafer firmly to the skin
surrounding the stoma and
smoothen the edges.
24. Tapes the wafer firmly to the skin
surrounding the stoma and
smoothen the edges.
25. Checks that the pouch and closure
are secured and comfortable.
26. Washes hands and dispose all soiled Reduces transmission of microorganisms.
items in the back bag.
27. Checks for peristomal skin integrity.
28. Document the following:
a. Assessment of the
peristomal skin and stoma. Detects and reports any abnormality or
b. Stoma measurements complications.
c. Color and amount of
drainage
d. Any skin breakdown an
peristomal skin care done
e. Type of ostomy pouch
applied.