LESSON PLAN ON

RYLE’S TUBE FEEDING

Subject: Clinical speciality IA
Topic: Ryle’s tube feeding
Group:
Date and Time:
Venue:
Method of teaching: demonstration
Teaching aids:

Aim: At the end of procedure group will be able to demonstrate the procedure skillfully
Specific objectives: At the of the procedure group will be able
 To enlist the purposes of ryle’s tube feeding
 To identify the indications of ryle’s tube feeding
 To enlist the contraindications of ryle’s tube feeding
 To prepare the patient before procedure
 To arrange the articles needed for procedure
 To demonstrate the procedure
 To explain the scientific principles of procedure

TIME CONTRIBUTORY CONTENT TEACHING AV

 OBJECTIVES LEARNING AIDS
ACTIVITIES
2 min Introduction Teacher will
Whenever the patient is unable to feed by mouth food must be introduced introduce the
by some other route. Gastric gavage is an artificial method of giving fluids procedure
and nutrients through a tube. The tube is passed into the oesophagus
Group will be able to through the nose, mouth or through the opening made on the abdominal
define ryle’s tube wall.
Teacher will
feeding Definition define the
Nasogastric tube feeding is defined as the delivery of nutrients from the nasal
route into the stomach via a feeding tube. procedure
Group will be able to
enlist the purposes of Teacher will
ryle’s tube feeding Purposes
enlist the
 To Provide Adequate Nourishment to Patient Who Cannot Feed
purposes of ryles
themselves.
tube feeding
 To Administer Medication
 To Provide Nourishment To Patients Who Cannot Be Fed Through
Mouth. For eg. Surgery In Oral Cavity , Unconscious Or Comatose
State
Group will identify the Teacher will
indications of ryle’s Indication identify the
tube feeding  Unconscious patients indications of
 Swallowing disorders ryle’s tube
 Physiological anorexia eg cancer, sepsis, HIV feeding
 GI dysfunction eg. Inflammatory bowel disease
 Increased nutritional requirements eg burns
Group will be able to  Psychological problmes eg anorexia nervosa
enlist the Teacher will
contraindications enlist the
Contraindications contraindications
  Basal skull fractures
 Unstable cervical spinal injuries
 Nasal/pharyngeal /oesophageal obstruction or ulceration
 Choanal atresia
Group will be able to  Trachoesophageal fistula
prepare the patient Teacher will
 Oesophageal stricture prepare the
patient for
Patient preparation procedure
 Assess the patient abdomen for presence of distension, palpate
abdomen for firmness or tenderness, auscultate abdomen for bowel
sounds
 If found tenderness, rigidity, absence of bowel sounds inform
Group will arrange the physician
articles needed for  Check for any special instructions regarding food allergy, Teacher will
procedure positioning related instructions arrange the
 Check for level of consciousness of patient articles needed
 Identify patient’s name, bed number, identification data for procedure

Articles preparation
A tray containing
1. Formula feed
2. Measuring cup
3. 10 ml syringe
Group will be able to 4. Large syringe of 50-60 ml Teacher will
demonstrate the 5. Water in container explain and
procedure 6. Stethoscope demonstrate the
7. Kidney tray procedure
8. Towel with mackintosh
9. Clean gloves
10. Paper bag
Procedure
Nursing action
1. Identify the patient and explain the
procedure to patient that feeding will
take around 10-15 minutes. Also
explain patient that patient will
experience feeling of fullness after
feeding
2. Place container with feed in warm
water
3. Assist patient to fowler’s position
4. Wash hands
5. Spread towel and mackintosh over
patient’s chest
6. Don gloves and attach 10 ml syringe to
nasogastric tube
7. Aspirate the gastric content, if there is
any doubt in placement of tubing
inform physician and perform chest x-
ray
8. If residual content is within normal
limit and placement of tube is accurate
then start feeding
Rationale
Proper explanation
relieves anxiety of patient
and explanation to be
given to unconscious
patients as they may hear
and perceive instructions
Warms the fluid to be feed
Fowler’s position enhance
gravitational force and
prevent risk of aspiration
Prevents transportation of
infection
To prevent soiling of
clothes and linen
If residual gastric contents
exceed 100ml for
intermittent feeding or
greater than 1.5 times than
hourly rate for continuous
feeding withhold feed and
inform physician
Pinching tube prevents air
 from entering the stomach
9. Pinch the tube and attach the syringe which causes distension

Water clears the tube and

10. Fill syringe with water and allow fluid rate of flow is regulated by
to flow by gravity by raising barrel raising and lowering the
above level of patient’s head syringe

Prevents air form entering

11. Pour feed into syringe barrel and allow
it to flow by gravity. Keep on pouring
feed to barrel when it is three quarters
empty. Pinch tube whenever necessary
to stop when pouring Prevents clogging of
feeding tube
12. After feeding is completed, flush tube
with at least 30 ml water
Prevents leakage

13. After tube is cleared close end of

feeding of tube

14. Rinse equipment with warm water and

dry
15. Keep head of bed elevated for 30-60
minutes after feeding
16. Wash hands
Group will explain the
scientific principles of 17. Document the type and amount of
procedure feeding, amount of water given and Teacher will
tolerance of feed Evaluates for aspiration explain the
effects on GI system and scientific
 therapeutic effect of principles of
18. Monitor for breath sounds, bowel feeding procedure
sounds, gastric distension, diarrhea, May indicate intolerance
constipation and intake and output of feeding

19. Instruct patient to notify nurse if he

experience sensation of fullness,
vomiting

Documentation
 Describe and record procedure
 Time of feeding
 Type of Gavage feeding
 Type and amount of fluid given
 Amount retained or vomited
 Patient’s reaction to the procedure.

Scientific principles
1.Anatomy and physiology
 A thorough knowledge of the anatomy and physiology of the
digestive tract and respiratory tract, ensures safe induction of the
tube (avoid misplacement of the tube
 There are many pouches in the respiratory and digestive tract where
the tube may remain kinked. E.g. nasal cavity, oral cavity etc.
therefore, it is necessary to pass the tube along the curve of the
digestive tract.
 As trachea is in front of the oesophagus, it has got every chance of
the tube to enter into the trachea and cause asphyxia in the client.
Therefore, the nurse should know the sign of the correct placement
of the tube.
  The mucus membrane lines the digestive tract and it can be injured
by friction when the tube is passed carelessly or without proper
lubrication.
 The length of the tube that is introduced should correspond to the
length of the digestive tract extending from the digestive tract
extending from the nostrils to the stomach which can be measured
by the distance taken from the bridge of the nose to the ear lobe plus
the distance from the ear lobe to the tip of the xiphoid process of the
sternum. It is about 10 to 12 inches.
 The stomach is never completely empty, it contains some gastric
juice. Aspiration of the fluid through the tube indicates the presence
of the tube in the stomach and not in the trachea.

2. Microbiology
 All equipment used for feeding should be clean. Separate articles
may be kept for individual clients to prevent cross infection
 Many organisms enter the body through the food and drink. The
food has to be prepared, handled and stored under good hygienic
conditions. 
 The clients who are receiving tube feeding need frequent mouth
care.
 The tube that is lying outside the nostrils needs cleaning to prevent
the entry of bacteria into the gastrointestinal tract.

3. Psychology
 Explain the procedure to the patient and clarify all the doubts to
gain cooperation
 Provide privacy if patient is uncomfortable
4. Physics and chemistry
Regulate the flow of feed by adjusting the position of the syringe by raising
feed flows by gravity.

Summary
We have seen about the ryle’s tube feeding its purposes, indications,
contraindications, articles, procedure and scientific principles of procedure

Conclusion
Providing nutrition is the vbasic need of human hence patient who are
unable to take food by their own can be feed with nasogastic feeding or
ryle’s tube feeding.

Bibliography
Sister cecy coriea 2013 principles and practice of nursing : art
of nursing procedure Volume 1 Jaypee publication