PGT Batch 6: Logo Here

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PGT Batch 6
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Question 1
a) NG Tube, asepto syringe, plaster, gloves, measuring cup, litmus paper
b) NG Tube, asepto syringe, plaster, gloves, stethospcope, litmus paper

c) NG Tube, Tuberculin syringe, plaster, gloves, measuring cup, litmus paper d) NG Tube, asepto syringe, plaster, gloves, measuring cup, litmus paper
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Answer
c) NG Tube, Tuberculin syringe, plaster, gloves, measuring cup, litmus paper
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Usually inserted to decompress the stomach, a nasogastric tube (NG) tube prevent vomiting after major surgery. A NG typically is in place for 48-72 hours after surgery, by which time peristalsis usually resumes.
The NG tube can also be used to assess and treat: Upper GI bleeding Collect gastric contents for analysis Perform gastric lavage Aspirate gastric secretions Administer medications and nutrients
Equipments needed
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Equipments needed
Tube (usually #12, #14, #16 or #18 French for a normal adult.
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Equipments needed
Towel or linen-saver pad
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Equipments needed
Penlight
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Equipments needed
1 or 2 hypoallergenic tape or Opsite
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Equipments needed
Gloves
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Equipments needed
Water soluble lubricant
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Equipments needed
Cup or glass of water with straw (if appropriate)
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Equipments needed
Stethoscope
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Equipments needed
Tongue blade
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Equipments needed
Catheter-tip or bulb syringe or irrigation set
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Equipments needed (optional)

Metal clamp
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Ice
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Alcohol pad
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Warm water
(in the picture is a hot water bag)
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Large basin or plastic container
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Question 2
a) When patient has flu
b) When patient has toothache c) When patient had facial injuries d) When patient refuses
Answer
c) When patient had facial injuries
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Question 3
a) True
b) False c) Both d) None of the above

Question 4
a) coiling it in your gloved hand and chilling the tube in the freezer
b) coiling it in your gloved hand dipping the tube in warm water

c) coiling it in your gloved hand and dipping the tube in tap water d) coiling it in your gloved hand and dipping in cold water
Answer
b) coiling it in your gloved hand dipping the tube in warm water
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Preparation
To ease insertion, increase a stiff tubes flexibility by coiling it around your finger for a few seconds or by dipping it into warm water. Stiffen a limp rubber tube by briefly chilling it in ice.
Question 5
a) Let the doctor measure the length.
b) hold the end of the tube at pt's nose and extend down to the xiphoid process.
c) hold the end of the tube at the upper of the pt's nose, extend to the lower earlobe then down to the xiphoid process. d) hold the end of the tube at the tip of the pt's nose, extend to the earlobe then down to the xiphoid process.
Answer
d) hold the end of the tube at the tip of the pt's nose, extend to the earlobe then down to the xiphoid process. (NEX)
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Question 6
a) True
b) False c) Sometimes d) None of the above

Answer
b) False
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Question 7
a) 1-2 inches.
b) 3-4 inches c) 5-8 inches d) do not lubricate as this may harm the patient
Answer
b) 3-4 inches
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Question 8
a) Gently rotate the tube 180 degrees toward the opposite nostril and pass the tube just above the oropharynx
b) Stop, give client water w/ a straw, have him flex head forward, and
swallow small sips of water. Advance tube w/ each swallow
c) Call the doctor d) Have client speak, inspect posterior pharynx to check placement.
Answer
a) Gently rotate the tube 180 degrees toward the opposite nostril and pass the tube just above the oropharynx
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Question 9
a) Have client speak, inspect posterior pharynx to check placement.
b) Gently rotate the tube toward the opposite nostril and pass the tube just
above the oropharynx.
c) Call the supervisor d) Stop, give client water w/ a straw, have him flex head forward, and swallow small sips of water. Advance tube w/ each swallow.
Answer
d) Stop, give client water w/ a
straw, have him flex head

forward, and swallow small sips of water. Advance tube w/ each swallow.
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Question 10
a) Hyperextend the pt's head
b) position the client in a High-Fowler's (90-degree angle) c) Have client speak d) Call the charge nurse
Answer
c) Have client speak
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Inserting a NG tube
Explain the procedure to the patient. Tell her that she may experience some discomfort and that swallowing will ease the tubes advancement.
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Inserting a NG tube
Help the patient into high Fowlers position unless contraindicated.
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Inserting a NG tube
Provide privacy Stand at the patients right side if youre righthanded or at her left side if you lefthanded to ease insertion.
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Inserting a NG tube
Drape the towel or linen-saver pad over the patients chest.
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Inserting a NG tube
To determine which nostril will allow easier access, use a penlight and inspect for a deviated septum or other abnormalities. Wash hands and wear sterile gloves
Inserting a NG tube
To determine how long the NG tube must be to reach the stomach, hold the end of the tube at the tip of the patients nose. Extend the tube to the patients earlobe and then down to the xiphoid process.
Inserting a NG tube
Mark this distance on the tubing with tape.
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Inserting a NG tube
Lubricate the first 3 (7.6 cm) of the tube with a water-soluble gel. Instruct the patient to hold her head straight and upright. Grasp the tube with the end pointing downward, curve it if necessary, and carefully insert it into the more patient nostril.
Inserting a NG tube
Aim the tube downward and toward the ear closest to the chosen nostril. Advance it slowly to avoid pressure on the turbinates and resultant pain and bleeding.
Inserting a NG tube
When the tube reaches the nasopharynx, youll feel resistance.
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Inserting a NG tube
Instruct the patient to lower her head slightly to close the trachea and open the esophagus.
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Inserting a NG tube
Then rotate the tube 180 degrees toward the opposite nostril to redirect it so that the tube wont enter the patients mouth.
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Inserting an NG tube
Unless contraindicated, offer the patient a cup of water with a straw. Direct her to sip and swallow as you slowly advance the tube. This helps the tube pass to the esophagus. (If you arent using water, ask the patient to swallow.)
Question 10
a) Immediately before insertion when administering irrigations, medications, tube feedings
b) Immediately after insertion when administering irrigations, medications,

tube feedings
c) Immediately during insertion when administering irrigations, medications, tube feedings d) There is no need to check the placement as per doctors order
b) Immediately after insertion when administering irrigations, medications, tube
feedings
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Ensuring proper tube placement

Use a tongue blade and penlight to examine the patients mouth and throat for signs of a coiled section of tubing.
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At the same time, auscultate for air sounds with your stethoscope placed over the epigastric region. You should hear a whooshing sound if the tube is patent and properly positioned in the stomach.

If these test dont confirm proper tube placement, youll need X-ray verification.
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Example of a CXR showing a misplaced NG tube


Secure the NG tube to the patients nose with hypoallergenic tape, (or other designated tube holder). If the patients skin is oily, wipe the bridge of her nose with an alcohol pad and allow to dry.
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Provide frequent nose and mouth care while the tube is in place. An NG tube may be inserted or removed at home.
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*Confirming NG tube placement

When confirming NG tube placement, never place the tubes end in a container of water. If the tube is malpositioned in the trachea, the patient may aspirate water.
*Confirming NG tube placement

Besides, water without bubbles doesnt confirm proper placement. Instead, the tube may be coiled in the trachea or the esophagus.
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Pointers
If these signs occur, remove the tube immediately. Allow the patient time to rest; then try to reinsert the tube. After tube placement, vomiting suggest tubal obstruction or incorrect position.
NGT FEEDING (BOLUS PROCEDURE)

Recheck doctors order Check for expiration and warm the feed solution Always wash your hands Check the placement of your feeding tube: Attach a 60cc syringe to the end of your feeding tube. Pull back on the plunger. You should see some gastric juices (yellow-green fluid). This is stomach content and tells youre the tube is in your stomach.
WARNING! If you pull back more than 150cc of fluid, do not give yourself food. Inject the stomach content, which contains important minerals, back into the tube. Then flush with water. Wait for a few hours and check again. Tell your visiting nurse or your doctor if this occurs frequently.
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Removing a NG tube
Check Doctors Order Explain the procedure to the patient and that it may cause some discomfort.
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Removing a NG tube
Help the patient into semi-Fowlers position. Assess bowel sounds. Then drape a towel or linen-saver pad across her chest to protect her from spills.
Removing a NG tube
Put on gloves. Using a catheter-tip syringe, flush the tube with 10ml of normal saline solution to ensure that the tube doesnt contain stomach contents that could irritate tissues during tube removal.
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Removing a NG tube
Untape the tube from the patients nose, and then unpin it from her gown.
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Please wear gloves!!!
Removing a NG tube
Clamp the tube by folding it in your hand.
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Removing a NG tube
Ask the patient to hold her breath to close the epiglottis. Then withdraw the tube gently and steadily. (when the distal end of the tube reaches the nasopharynx, you can pull it quickly.)
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Please wear gloves!!!
Removing a NG tube
Assist the patient with thorough mouth care, and clean the tape residue from her nose with adhesive remover. Do after care
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Question 11
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Check proper placement of the NGT in the stomach (NGT patency)
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Question 12
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Stop the feeding

immediately and notify attending physician.
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Question 13
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Dumping syndrome
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Question 14
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Question 15
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Enteral Tube Feeding
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Nasogastric tube insertion
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Removing NG Tube
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+12 34 567 890

Street Address 12345, City, Country

a) NG Tube, asepto syringe, plaster, gloves, measuring cup, litmus paper

b) NG Tube, asepto syringe, plaster, gloves, stethospcope, litmus paper

c) NG Tube, Tuberculin syringe, plaster, gloves, measuring cup, litmus paper

+12 34 567 890

Street Address 12345, City, Country

+12 34 567 890

Street Address 12345, City, Country

+12 34 567 890

Street Address 12345, City, Country

+12 34 567 890

Street Address 12345, City, Country

+12 34 567 890

Street Address 12345, City, Country

+12 34 567 890

Street Address 12345, City, Country

+12 34 567 890

Street Address 12345, City, Country

+12 34 567 890

Street Address 12345, City, Country

+12 34 567 890

Street Address 12345, City, Country

+12 34 567 890

Street Address 12345, City, Country

+12 34 567 890

Street Address 12345, City, Country

+12 34 567 890

Street Address 12345, City, Country

Equipments needed (optional)

+12 34 567 890

Street Address 12345, City, Country

Equipments needed (optional)

+12 34 567 890

Street Address 12345, City, Country

Equipments needed (optional)

+12 34 567 890

Street Address 12345, City, Country

Equipments needed (optional)

+12 34 567 890

Street Address 12345, City, Country

Equipments needed (optional)

+12 34 567 890

Street Address 12345, City, Country

a) When patient has flu

c) When patient had facial injuries

+12 34 567 890

Street Address 12345, City, Country

b) False c) Both d) None of the above

b) coiling it in your gloved hand dipping the tube in warm water

b) coiling it in your gloved hand dipping the tube in warm water

+12 34 567 890

Street Address 12345, City, Country

a) Let the doctor measure the length.

+12 34 567 890

Street Address 12345, City, Country

b) False c) Sometimes d) None of the above

+12 34 567 890

Street Address 12345, City, Country

+12 34 567 890

Street Address 12345, City, Country