Inserting a NG tube

The nurse is preparing to insert a nasogastric (NG) tube into an adult client. Place the following steps in the correct order. Use all options.

1)Place the client in high Fowler's position. 2)Measure the intended length to insert the NG tube. 3)Lubricate the tube tip with water-soluble lubricant. 4)Direct the tube upward and backward along the floor of the nose. 5)Instruct the client to place the chin onto the chest. 6)Advance the tube while the client swallows. Rationale: An upright position is more natural for swallowing and protects against bronchial intubation aspiration, if the client should vomit. Therefore, the high Fowler's position is recommended for the client. Measurement ensures that the tube will be long enough to enter the client's stomach. Lubrication reduces friction and facilitates passage of the tube into stomach. Following the normal contour of the nasal passage while inserting the tube reduces irritation and the likelihood of mucosal injury. Bringing the head forward helps close the trachea and open the esophagus. Swallowing helps advance the tube, causes the epiglottis to cover the opening of the trachea, and helps to eliminate gagging and coughing.

The nurse has just confirmed proper placement of a nasogastric tube. Which action should the nurse take next?

Apply skin barrier to the tip and end of the nose. Rationale: Skin barrier improves adhesion and protects the skin. Applying the skin barrier should occur before taping the tube to the client's nose, measuring the length of exposed tube, or lubricating the lips.

A nurse is assessing a client who has recently had bowel surgery and will be receiving a nasogastric tube. Which finding would most likely contraindicate placement of a nasogastric (NG) tube by the nurse in this client?

History of facial fractures Rationale: Clients with facial fractures or facial surgeries present a higher risk for misplacement of the tube into the brain. Many institutions require a health care provider to place NG tubes in these clients, which would contraindicate the nurse placing the tube. The nurse should assess the patency of the client's nares by asking the client to occlude one nostril and breathe normally through the other. However, the nurse does this to select the nostril through which air passes more easily, not because one nare being less patent than the other is a contraindication for NG tube placement by the nurse. Abdominal distention does not contraindicate NG tube placement. Monitoring bleeding in the gastrointestinal (GI) tract is one of the indications for NG tube placement, so bleeding in the GI tract is not a contraindication.

The nurse has begun inserting the nasogastric (NG) tube when the client coughs. After assessing that the client can speak without difficulty, what does the nurse do next?

Proceed with nasogastric tube placement. Rationale: The nurse first ensures that any coughing is related to the gag reflex rather than accidental placement of the NG tube into the airway. When the client breathes and speaks adequately, placement may continue. The nurse has performed the necessary respiratory assessment by ensuring the client can speak well. There is no reason to begin again with the other nostril or to notify the health care provider.

Following insertion of a nasogastric tube, the nurse needs to stabilize the tubing for the client. Which action is appropriate for the nurse to take?

Secure the tubing with a safety pin to the client's gown at shoulder level. Rationale: The nurse would secure the tube to the client's gown at the sleeve by using a safety pin, and perhaps a rubber band, ensuring that the air vent is above the level of the stomach. Securing the tube prevents tension and tugging on the tube. Securing the tube in any other place and in any other manner or failure to secure the tube at all can allow the tube to be accidentally removed, possibly requiring reinsertion.

The nurse is slowly advancing a nasogastric (NG) tube when the client begins to gasp and is unable to vocalize. Which has likely occurred?

The NG tube is in the client's airway. Rationale: The tube is in the airway if the client shows signs of distress and cannot speak or hum. Excessive coughing and gagging may occur if the tube has curled in the back of throat. A vasovagal reaction is typically manifested by lightheadedness and fainting, not by gasping and an inability to vocalize. There is no indication that the client is forcefully resisting the procedure.

Which documentation does the nurse complete after inserting a client's nasogastric (NG) tube?

measurement of the exposed tube Rationale: The nurse would document the size and type of NG tube that was inserted, the nare used for insertion, the measurement of the exposed tube, the characteristics of the drainage in the tube, and the client's reaction to the procedure. It is not relevant to know how long the NG insertion took or how difficult it was, unless there was trauma. Placing an NG tube is procedure that is not expected to alter the client's vital signs, and it will not immediately alter the client's bowel sounds.

After measuring from the client's nostril to the ear lobe, how does the nurse continue to measure the length of the nasogastric (NG) tube to be inserted for a client?

to the xiphoid process Rationale: Rationale:The nurse measures the distance to insert the NG tube by placing the tip of the tube at client's nostril and extending to the tip of the ear lobe and then to the tip of the xiphoid process. This measurement ensures that the tube will be long enough to enter the client's stomach without needless coiling. Measuring to the mammary line is too short by about 1 in (2.5 cm) and to the tenth intercostal space or the umbilicus is too long.

After putting on gloves, the nurse lubricates the nasogastric (NG) tube prior to insertion into the client's nares. Which lubricant is appropriate to use?

water-soluble lubricant Rationale: The nurse would lubricate the tip of the tube with water-soluble lubricant. Lubrication reduces friction and facilitates passage of the tube into the stomach. Water-soluble lubricant will not cause pneumonia if the tube accidentally enters the lungs. Saline and water are not considered lubricants. Jelly-based lubricants can be dangerous, particularly if aspirated.