1. The client/caregiver can define nasogastric tube feedings.
    1. When swallowing is severely impaired, a nasogastric tube may be inserted.
    2. The nasogastric tube is inserted through the nose and it reaches to the stomach. This will bypass the mouth, throat, and esophagus.
    3. The client can receive complete nutrition without eating/swallowing.
    4. It can be given continuously or intermittently.
    5. The nasogastric tube is commonly used when the swallowing/eating problem is expected to last less than a month.
  2. The client/caregiver can demonstrate the nasogastric tube feeding procedure.
    1. Gather all equipment.
    2. Wash hands.
    3. Put client in an upright position.
    4. Aspirate stomach contents to check for residual and then return aspirated contents to stomach. (Hold feeding if the residual is greater than 50 to 100 ml and notify the physician.)
    5. Check position of the tube.
      1. Using a syringe, inject 10 ml of air into the tube, and listen with a stethoscope over the stomach to hear a whoosh of air.
    6. Pour room-temperature feeding solution into the bag and prime tubing by filling it with a formula to prevent air from going into the stomach.
    7. Connect to the preprogrammed pump and attach it to the nasogastric tube. Set the pump for the amount required and rate for flow.
    8. If the pump is unavailable, attach the feeding bag tube to the nasogastric tube and open the clamp to allow the solution to flow.
    9. Use drip rate as ordered by a physician if ordered continuously.
    10. Allow approximately 20 to 30 minutes for each feeding if feedings are intermittent. Avoid rapid infusion to avoid nausea and vomiting.
    11. Assess tolerance of feeding. Stop feedings and report to a physician for symptoms such as
      • Coughing
      • Choking
      • Gagging
      • Vomiting
    12. Follow feeding by flushing with 50 to 150 cc of water.
    13. Keep the client in an upright position for at least 15 to 30 minutes after the feeding.
  3. The client/caregiver can list measures to prevent complications.
    1. Wash hands well, and keep the working area very clean to prevent infection.
    2. Weigh regularly to prevent weight loss.
    3. Keep the head of the bed elevated at least 30 degrees.
    4. Refrigerate opened cans of feeding solutions, and discard after 24 hours to prevent spoilage.
    5. Formula must not hang for more than 8 hours.
    6. Check the position of the tube before each feeding or administration of medications.
    7. Flush tube as ordered to prevent clogging.
    8. Monitor blood sugar if diabetic, and report to the physician.
    9. Cleanse the nose and apply a water-based jelly to prevent skin breakdown.
    10. Provide mouth care.
    11. Check that the tube is secure to the face, and avoid tension on the tube during feedings.
    12. Wear Medic Alert bracelet to inform others of medical information.
    13. Report any intolerance of feeding solution to the physician (i.e., nausea, vomiting, cramping, diarrhea, and abdominal distention).
    14. Keep follow-up appointments with the physician and laboratory.
  4. The client/caregiver can list possible complications.
    1. Infection
    2. Aspiration pneumonia
    3. Clogging of the tubing
    4. Respiratory distress
    5. Diarrhea, nausea, or vomiting
    6. Inadequate nutrition

Resources

Medical supply companies
Dietician

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. St. Louis: Mosby Inc.Canobbio, M. M. (2006). Mosby’s handbook of patient teaching. St. Louis: Mosby Inc.Lutz, C., & Przytulski, K. (2001). Nutrition and diet therapy. Philadelphia: F. A. Davis Company.Perry, A., & Potter, P. (2006). Clinical nursing skills & technique. St. Louis: Mosby Inc.Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott

Credits

Client Teaching Guides for Home Health Care, 2nd ed.© 2008 Jones and Bartlett Publishers, Inc.www.jbpub.com

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