Week 14:

Enteral Feeding
(Orogastric / NGT Insertion, Gavage and Removal)

ENTERAL FEEDINGS it should be replaced with a new tube

according to institution’s policy, specific
The gastrointestinal (GI) system is an orders, and the type of tube to be used.
extensive region composed of various Hand washing should be performed before
organs. to prevent bacterial contamination of the
The GI system is responsible for ingestion feeding, especially during continuous-drip
and metabolism of nutrients for all parts of feedings.
the body.
Problems with the system can abruptly
affect other body systems and functions INITIATING AN ENTERAL FEEDING FOR AN
and will consequently affect overall health, INFANT
growth, and development.
Enteral feedings, also called nasogastric
tube feedings, are a common means of PURPOSE:
To supply Nutrition, Medication and
supplying adequate nutrition to an infant
Hydration by an Enteral tube
who is unable to suck or tires too easily
when sucking, or to an older child who
cannot eat. INDICATIONS:
This is used for infants and children
Enteral feedings have the advantage over
who have inadequate or unsafe oral
parenteral nutrition because they preserve
intake but with a functioning GI tract.
the stomach mucosa and also decrease the
risk of intravenous infection. In infants,
such feedings are traditionally called CONTRAINDICATION:
The only absolute contraindication is a
gavage feedings.
non-functioning GI tract, such as GI
obstruction or severe intestinal
Therapeutic management for gastrointestinal ischemia.
conditions in children which may include
alternative methods of feedings such as
enteral feedings. MATERIALS:
Feeding tube (usually French 8 or 10)
OROGASTRIC INSERTION as ordered. (Note: Polyethylene and
polyvinylchloride tubes lose their
allows for easier breathing because the
flexibility and need to be replaced
nose is not blocked.
frequently, usually ever 3 to 4 days.
Because newborns are nose breathers,
Polyurethane and silicone tubes can
it seems reasonable that passing a
remain in place up to 30 days).
catheter through the mouth in this size
A 10- ml barrel syringe to aspirate
infant will lead to less distress than
stomach contents after the tube has
passing it through the nose.
been placed Stethoscope
Orogastric insertion can also decrease
Water or water-soluble lubricant to
the possibility of striking the vagal
lubricate the tube; sterile water is used
nerve and causing bradycardia.
for infants
If the tube is to be left in place,
Paper tape or non-allergenic tape to
however, it may be passed through a
mark the tube and to attach the tube to
nostril.
the infant’s or child’s cheek (and nose if
For the older child, insertion through a
placed in the nares)
nostril is more comfortable.

Once the tube is inserted, it can be left in PROCEDURE

Loosely swaddle the infant using a
place or inserted or removed after each
mummy restraint. Place child supine
feeding, as ordered by the physician.
with head slightly hyperflexed or in a
An indwelling tube is almost always placed
sniffing position (nose pointed toward
through the nose. When it is ordered to be
ceiling).
removed,
Rein Ramos
ACADEMICIAN
 Week 14:
Enteral Feeding
(Orogastric / NGT Insertion, Gavage and Removal)
Measure the space from the bridge of the
nose to the earlobe to a point halfway
between the xiphoid process and the
umbilicus using no. 8 or no. 10 feeding
tube.
Evidence-Based Practice (EBP): The
morphologic measure most commonly
used by clinicians (nose-ear-xiphoid
distance) is often too short to locate the
entire tube pore span in the stomach.
However, the nose-ear-midxiphoid
umbilicus (NEMU) span approached the
accuracy of the age-specific prediction
equations and is easier to use in a
clinical setting.
The best option is to adapt the NEMU
measurement for NGT or OGT lengths.
Mark the tube at the measured point with a
small clamp or a piece of tape. Lubricate
the tip of the catheter with water.
Pass the catheter with gentle pressure to
the point of the clamp or tape. If the
catheter is inadvertently passed into the
trachea rather than the esophagus, the
infant usually will cough and become
dyspneic. If this happens, withdraw and
replace the catheter.
When using the nose, slip the tube
along the base of the nose and direct it
straight back toward the occiput.
When entering through the mouth,
direct the tube toward the back of the
throat.
If the child is able to swallow on
command, synchronize passing the
tube with swallowing
Rein Ramos
ACADEMICIAN
Assess the catheter for position to confirm
that it is not in the trachea before
administering a feeding tube. Follow
hospital policy and/or doctor’s order. If
doubt exists regarding correct placement,
refer to the doctor.
Methods to Determine Proper Gavage Tube
Placement
If an x-ray is obtained to document
correct tube placement, measure
the length of the tube evident at
that time. Re-measure the length of
tube before a feeding to document
that the tube has not pulled out or
advanced further. This is the most
accurate method for testing tube
placement is radiography, this is not
always possible before each
feeding.
Attach syringe to the tube and
aspirate stomach contents. Test for
pH (below 7 is acid).
Inject 5 ml of air into the gavage
tube and listen over the stomach
with a stethoscope to the sound of
injected air.
Add the specific kind and amount of
feeding prescribed to the syringe or funnel.
Pour formula into the barrel or syringe
attached to the feeding tube. To start the
flow, give a gentle push with the plunger
but then remove the plunger and allow the
fluid to flow into the stomach by gravity.
Don’t elevate the syringe end of the tube
more than 12 inches above the infants’
abdomen.
Formula must be warmed to room
temperature. Do not microwave.
The rate of flow should not exceed 5 ml
every 5 to 10 minutes in premature and
very small infants and 10 ml/min in
older infants and children to prevent
nausea and regurgitation. A usual
feeding may take 15 to 30 minutes to
complete.
 Week 14:
Enteral Feeding
(Orogastric / NGT Insertion, Gavage and Removal)

recheck in 30 to 60 minutes. When

residual fluid is less than one fourth of
the last feeding, give the scheduled
feeding. If large amounts of aspirated
fluid persist and child is due for another
feeding, notify the practitioner.

Offer a pacifier (non-nutrient sucking)

during the feeding if the infant appears to
enjoy this.
When the feeding has passed through the
tube, re-clamp the tube securely and
gently and rapidly withdraws it.
If the tube is to remain in place, flush it
with sterile water (1 tor 2 ml for small tubes
to 5 to 15 ml or more for large tubes and
as ordered) to clear it of formula. Cap or
clamp it to prevent loss of feeding.
If the tube is to be removed, first pinch
it firmly to prevent escape of fluid as
the tube is withdrawn. Withdraw the
tube quickly but smoothly.
If the tube is to be left in place, tape it
below the nose and to the cheek. Do not
tape it to the forehead.
Position the child with head elevated 30 to
45 degrees or on the right side for 30 to 60
minutes. If the child’s condition permits,
bubble the baby after an enteral feeding as
you would after a bottle or breast feeding.
If a parent is present, encourage him or her
to do this.
Record the feeding, including the type and
amount of residual, the type and amount of
formula, and how it was tolerated. If a
parent observed the procedure, answer any
questions or concerns.
For most infants, any amount of
residual fluid aspirated from the
stomach is re-fed to prevent electrolyte
imbalance, and the amount is
subtracted from the prescribed amount
of feeding.
Another method: If residual fluid is
more than one fourth of the last
feeding, return the aspirate and
Rein Ramos
ACADEMICIAN
 Week 14:
Enteral Feeding
(Orogastric / NGT Insertion, Gavage and Removal)

ENTERAL FEEDINGS it should be replaced with a new tube

according to institution’s policy, specific
The gastrointestinal (GI) system is an orders, and the type of tube to be used.
extensive region composed of various Hand washing should be performed before
organs. to prevent bacterial contamination of the
The GI system is responsible for ingestion feeding, especially during continuous-drip
and metabolism of nutrients for all parts of feedings.
the body.
Problems with the system can abruptly
affect other body systems and functions INITIATING AN ENTERAL FEEDING FOR AN
and will consequently affect overall health, INFANT
growth, and development.
Enteral feedings, also called nasogastric
tube feedings, are a common means of PURPOSE:
To supply Nutrition, Medication and
supplying adequate nutrition to an infant
Hydration by an Enteral tube
who is unable to suck or tires too easily
when sucking, or to an older child who
cannot eat. INDICATIONS:
This is used for infants and children
Enteral feedings have the advantage over
who have inadequate or unsafe oral
parenteral nutrition because they preserve
intake but with a functioning GI tract.
the stomach mucosa and also decrease the
risk of intravenous infection. In infants,
such feedings are traditionally called CONTRAINDICATION:
The only absolute contraindication is a
gavage feedings.
non-functioning GI tract, such as GI
obstruction or severe intestinal
Therapeutic management for gastrointestinal ischemia.
conditions in children which may include
alternative methods of feedings such as
enteral feedings. MATERIALS:
Feeding tube (usually French 8 or 10)
OROGASTRIC INSERTION as ordered. (Note: Polyethylene and
polyvinylchloride tubes lose their
allows for easier breathing because the
flexibility and need to be replaced
nose is not blocked.
frequently, usually ever 3 to 4 days.
Because newborns are nose breathers,
Polyurethane and silicone tubes can
it seems reasonable that passing a
remain in place up to 30 days).
catheter through the mouth in this size
A 10- ml barrel syringe to aspirate
infant will lead to less distress than
stomach contents after the tube has
passing it through the nose.
been placed Stethoscope
Orogastric insertion can also decrease
Water or water-soluble lubricant to
the possibility of striking the vagal
lubricate the tube; sterile water is used
nerve and causing bradycardia.
for infants
If the tube is to be left in place,
Paper tape or non-allergenic tape to
however, it may be passed through a
mark the tube and to attach the tube to
nostril.
the infant’s or child’s cheek (and nose if
For the older child, insertion through a
placed in the nares)
nostril is more comfortable.

Once the tube is inserted, it can be left in PROCEDURE

Loosely swaddle the infant using a
place or inserted or removed after each
mummy restraint. Place child supine
feeding, as ordered by the physician.
with head slightly hyperflexed or in a
An indwelling tube is almost always placed
sniffing position (nose pointed toward
through the nose. When it is ordered to be
ceiling).
removed,
Rein Ramos
ACADEMICIAN
 Week 14:
Enteral Feeding
(Orogastric / NGT Insertion, Gavage and Removal)
Measure the space from the bridge of the
nose to the earlobe to a point halfway
between the xiphoid process and the
umbilicus using no. 8 or no. 10 feeding
tube.
Evidence-Based Practice (EBP): The
morphologic measure most commonly
used by clinicians (nose-ear-xiphoid
distance) is often too short to locate the
entire tube pore span in the stomach.
However, the nose-ear-midxiphoid
umbilicus (NEMU) span approached the
accuracy of the age-specific prediction
equations and is easier to use in a
clinical setting.
The best option is to adapt the NEMU
measurement for NGT or OGT lengths.
Mark the tube at the measured point with a
small clamp or a piece of tape. Lubricate
the tip of the catheter with water.
Pass the catheter with gentle pressure to
the point of the clamp or tape. If the
catheter is inadvertently passed into the
trachea rather than the esophagus, the
infant usually will cough and become
dyspneic. If this happens, withdraw and
replace the catheter.
When using the nose, slip the tube
along the base of the nose and direct it
straight back toward the occiput.
When entering through the mouth,
direct the tube toward the back of the
throat.
If the child is able to swallow on
command, synchronize passing the
tube with swallowing
Rein Ramos
ACADEMICIAN
Assess the catheter for position to confirm
that it is not in the trachea before
administering a feeding tube. Follow
hospital policy and/or doctor’s order. If
doubt exists regarding correct placement,
refer to the doctor.
Methods to Determine Proper Gavage Tube
Placement
If an x-ray is obtained to document
correct tube placement, measure
the length of the tube evident at
that time. Re-measure the length of
tube before a feeding to document
that the tube has not pulled out or
advanced further. This is the most
accurate method for testing tube
placement is radiography, this is not
always possible before each
feeding.
Attach syringe to the tube and
aspirate stomach contents. Test for
pH (below 7 is acid).
Inject 5 ml of air into the gavage
tube and listen over the stomach
with a stethoscope to the sound of
injected air.
Add the specific kind and amount of
feeding prescribed to the syringe or funnel.
Pour formula into the barrel or syringe
attached to the feeding tube. To start the
flow, give a gentle push with the plunger
but then remove the plunger and allow the
fluid to flow into the stomach by gravity.
Don’t elevate the syringe end of the tube
more than 12 inches above the infants’
abdomen.
Formula must be warmed to room
temperature. Do not microwave.
The rate of flow should not exceed 5 ml
every 5 to 10 minutes in premature and
very small infants and 10 ml/min in
older infants and children to prevent
nausea and regurgitation. A usual
feeding may take 15 to 30 minutes to
complete.
 Week 14:
Enteral Feeding
(Orogastric / NGT Insertion, Gavage and Removal)

recheck in 30 to 60 minutes. When

residual fluid is less than one fourth of
the last feeding, give the scheduled
feeding. If large amounts of aspirated
fluid persist and child is due for another
feeding, notify the practitioner.

Offer a pacifier (non-nutrient sucking)

during the feeding if the infant appears to
enjoy this.
When the feeding has passed through the
tube, re-clamp the tube securely and
gently and rapidly withdraws it.
If the tube is to remain in place, flush it
with sterile water (1 tor 2 ml for small tubes
to 5 to 15 ml or more for large tubes and
as ordered) to clear it of formula. Cap or
clamp it to prevent loss of feeding.
If the tube is to be removed, first pinch
it firmly to prevent escape of fluid as
the tube is withdrawn. Withdraw the
tube quickly but smoothly.
If the tube is to be left in place, tape it
below the nose and to the cheek. Do not
tape it to the forehead.
Position the child with head elevated 30 to
45 degrees or on the right side for 30 to 60
minutes. If the child’s condition permits,
bubble the baby after an enteral feeding as
you would after a bottle or breast feeding.
If a parent is present, encourage him or her
to do this.
Record the feeding, including the type and
amount of residual, the type and amount of
formula, and how it was tolerated. If a
parent observed the procedure, answer any
questions or concerns.
For most infants, any amount of
residual fluid aspirated from the
stomach is re-fed to prevent electrolyte
imbalance, and the amount is
subtracted from the prescribed amount
of feeding.
Another method: If residual fluid is
more than one fourth of the last
feeding, return the aspirate and
Rein Ramos
ACADEMICIAN
 Bachelor of Science in Nursing 2YB

NCMA219 RLE: BSN 2ND YEAR 2ND SEMESTER PRELIM 2022

Coverage for Prelim: Blood Rh factor
• Blood Transfusion
• Magnesium Sulfate Administration
• Measuring Intake and Output
• Spirituality Care

BLOOD TRANSFUSION
Discussed by Prof. Saracho and Prof. Cambel
- Introduction of whole blood or blood components into venous
circulation.
- Replace blood components to restore the blood’s ability to
transport oxygen and carbon dioxide, clot, fight infection, and
keep extracellular fluid within the intravascular compartment.
- A procedure in which a patient receives a blood through an Blood Types
intravenous line. • Blood typing - Determines the presence of the ABO and Rh
- The introduction of blood components into the venous (rhesus) antigens. (kung anong type na blood meron ka)
circulation. • Cross matching - Identify possible interactions of minor
- Process of transferring blood-based products from one person antigens (harmful) with corresponding antibodies.
into the circulatory system of another.

Purpose of Blood Transfusion

• To restore blood volume (e.g., may hemorrhage)
• To restore the oxygen-carrying capacity of the blood (RBC
carries hemoglobin. Kapag below 10 or 8 binibigyan ng blood
transfusion)
• To administer required blood components by the patient (e.g.
albumin, platelets, etc.)

Types of Blood
• A, B, O, AB
• O – for universal use, this can give to everyone
• AB – universal recipient

Blood products and Components

• Whole blood – simplest, most common
• the surface on our blood has antigens • Packed red blood cells (PRBC)
• antigens are important bec. it promotes agglutinations or • Autologous red blood cells
clamping of blood cells • Fresh frozen plasma
• Hal. kung type A ang blood ng patient at na salinan sya ng • Platelets
type B ang gagawin ng RBC magpo produce ng antibodies and • Albumin
it will against to the type B. The blood of pt. will hemolyzed • Cryoprecipitate
and could cause a lot of problem • Plasma protein factor

J.A.K.E 1 of 10
 NCMA219 RLE – BSN 2ND YEAR 2ND SEMESTER PRELIM 2022

Blood transfusion equipment

• Blood recipient set (filter & tubing with drip chamber for
blood or combined set)
• Blood product
• PNSS 250 ml (Normal Saline Solution)
• Blood transfusion set (Y-set)
• IV Catheters and needles 20G (venipuncture s)
• Multi lead tubing
• Clean gloves & alcohol swab
• IV pole
• Gown / PPE
• Face shield
• Infusion pump (optional)
• Ice bag or warm compress (optional)

Administering blood transfusion

Transfusion reaction
1) Assess the client’s
- Vital signs
- Physical examination (fluid balance, heart and lung
sounds, signs of hypo or hypervolemia, status of infusion
site, blood test results)
- Unusual symptoms (e.g., dizziness, itchiness – need to
determine bef. the transfusion to avoid confusion of
unusual symptoms)
2) Verify doctor’s order
- Right patient
- Number and type of units (blood product)
- Desired speed of infusion
- Pre-medications ordered
- Patient’s consent
3) Prepare the patient (GIE)
- Check ongoing IVF/ IV catheter
4) Perform hand hygiene
5) Prepare the infusion equipment
- Apply gloves
- Close all clamps on Y-set
- Spike into the saline solution
- Hang on the IV pole
- Open the upper clamp on the saline solution and squeeze
the drip chamber until it covers the filter and about 1/3
above the filter
- Prime the tubing (laglagyan mo ng saline solution yung
tube but first yung drip chamber muna then open the
control clamp para mag flow yung saline sa tube)
- Connect to client
- Start the saline solution

Code: A,F,H
- kapag nagkaroon ng mga gantong reaction stop the
transfusion.
Composition of blood
• Platelets concentrate PC
• Fresh frozen plasma FFP
• Cryoprecipitate anti-hemophilic factor Cyro-AHF

J.A.K.E 2 of 10
 NCMA219 RLE – BSN 2ND YEAR 2ND SEMESTER PRELIM 2022
6) Obtain the correct blood component from the blood bank.
Check for:
- Doctor’s order with requisition
- Requisition form and blood bag label (Laboratory
technician) – client’s name, ID #, blood type & Rh, blood
donor #, and expiration date
- Verify doctor’s order, transfusion consent form, client
identification, blood unit identification, blood type,
expiration date, compatibility, and appearance (with
another nurse)
- If the information does not match, notify the charge nurse
and blood bank
- Sign the appropriate form with another nurse
- Make sure the blood is left at room temperature for no
more than 30 minutes before starting transfusion.
7) Prepare the blood bag
- Invert the bag gently several times to mix the cells with
plasma
- Expose the port on the bag and spike the remaining Y-set
into the bag
- Hang on the IV pole
8) Establish the blood transfusion
- Close the upper clamp below the saline solution and open
the upper clamp below the blood bag
- Readjust the flow rate with the main clamp.
9) Remove and discard gloves
10) Perform hand hygiene
11) Observe the client closely for the first 15 minutes (initial
flow rate: 1-2ml/min)
- Assess for transfusion reaction
- Check VS after the initial 25 minutes
- After 15 minutes, adjust the flow rate into the computed
rate if no reactions were observed.
- Terminate the transfusion once blood is fully infused
- Flushed with saline solution
12) Document the procedure and relevant data
- Date & time procedure started, VS
- Type of blood, blood unit number, sequence number, site
of venipuncture, size of IV catheter, and flow rate
- Date & time of completion of transfusion, amount of
blood absorbed, blood unit number, VS
- If saline solution was continued, record connecting it.
- Record transfusion on the IV flow sheet and I & O record
Remember:
• AB – universal recipient
• O – universal donor
- Rhesus factors – inherited protein found on the surface of
the blood (meron syang antigen na letter D)
- Rh (+) – protein positive in the blood (D antigen)
- Rh (-) – lacks protein in the blood (No D antigen)
- Hal. ang isang pregnant pt. ay Rh (-), ang asawa RH (+)
and also the baby. Pwede magka problem, pero kapag
hindi naghalo ang dugo ng mommy and ng fetus walang
problem yun.
- Take NOTE: si mother nagpo provide ng nutrients sa
baby BUT not the BLOOD itself.
Paano na mae expose si mother sa blood ni baby?
- in delivery of the child nagkaroon ng rupture in the
uterus of the mother and the babies blood pass through
J.A.K.E 3 of 10
going towards the blood circulation of the mother, called
isoimmunization.
- Isoimmunization – meaning the blood of the mother and
the baby are not compatible
• Blood Typing – determines the type of the blood
• Crossmatching – determines the harmful antigen in the
recipient blood (kung compatible ba sila or hindi)
MAGNESIUM SULFATE ADMINISTRATION
Discussed by Prof. Melanie Cambel
Principle of Medication Administration
- Always assess a client’s health status and obtain a medication
history prior to giving any medication. The extent of the
assessment depends on the client’s illness or current condition,
the intended drug, and the route of administration.
Ten Rights of Medication Administration
1) Right Medication
- The medication given was the medication ordered.
- 3 times of reading the medication
- The first time you check the drug is when you received it
from pharmacy
- The second time you check the drug is before opening the
drug or aspirate the actual medication
- The last time you read the medication is before giving it
to the patient
2) Right Dose
- The dose ordered is appropriate for the client. Know the
usual dosage range of the medication.
- Give special attention if the calculation indicates multiple
pills/ tablets or a large quantity of a liquid medication.
This can be an indication that the math calculation may be
incorrect.
- Double-check calculations that appear questionable.
Question a dose outside of the usual dosage range.
- Formula for Drug Computation:
3) Right Time
- Give the medication at the right frequency and at the time
ordered according to agency policy.
- Medications should be given within the agency
guidelines.
4) Right Route
- Give the medication by the ordered route.
- Make certain that the route is safe and appropriate for the
client.
5) Right Client
- Medication is given to the intended client.
- Check the client’s identification band with each
administration of a medication.
- Know the agency’s name alert procedure when clients
with the same or similar last names are on the nursing
unit.
6) Right Client Education
- Explain information about the medication to the client
(purpose, possible side effects, any precautions).
- No need to memorize all the factors of the medication,
alamin lang yung mga side effects na pwedeng
maramdaman ng patient para kapag nag tanong ang
family may maibibigay kang explanation.