RNSG 1413 – Foundations for Nursing Practice

Module 4:  Nasogastric Intubation and Lavage

Module Objectives: 

Before coming to Lab, you should be able to:
  1. Discuss purposes of nasogastric tubes.
    • Gastric decompression (in the case of intestinal obstruction or absent parastalsis)
    • Lavage (removal of toxic substances or blood)
    • Feeding
  2. Discuss principles and concepts of care of the patient with an NGT.
  3. Understand the construction, purpose, and implications for management of different tube types.
  4. Discuss the differences between N/G, gastrostomy, and jejunostomy tubes used for feeding a patient including: location, diameter, advantages and disadvantages, safety precautions required, types of feedings to be used, impact on medication administration
  5. Describe the best type of formula for a patient with: Diabetes mellitus, Renal disease, Chronic pulmonary disease, Constipation, Milk allergies/intolerance
  6. State how to tell if a formula is isotonic or hypertonic.
  7. Describe nursing measures to be employed to prevent complications of enteral feedings: diarrhea, dehydration, infection, aspiration

Upon completion of the study of this module, the student should be able to:

  1. Identify the supplies necessary for insertion and discontinuation of basic nasogastric tubes.
  2. Correctly demonstrate steps involved in insertion and discontinuation of basic nasogastric tubes.
  3. Identify the supplies necessary and principles involved in maintaining gastric lavage.
  4. Safely irrigate an NGT.
  5. Assemble and administer enteral feedings: continuous, intermittent (cyclic or bolus), gravity drip, administered via a pump,
  6. Safely interrupt and reestablish a continuous enteral tube feedings.
  7. Demonstrate how to check for residual.
  8. Make decisions based on residual.
  9. Demonstrate how to flush a feeding tube.
  10. State methods for preventing the clogging of a feeding tube.
  11. Administer a medication via an enteral tube (per tube or PT): liquid medications, crushable/dissolvable medications, avoidance of enteric coated or time released medications, funnel and injection technique.

Learning Activities:


Review module objectives.

Read:  Harkreader -- (2nd edition, pp. 577-580, 547-553, 556-558 interventions to manage impaired swallowing, reduce aspiration), 3rd edition, pp. 629-32, 596-604, 591-92.

Recall:

  • A & P of GI and Respiratory tracts
  • Principles of physical assessment
  • Guidelines for calculation of intake and output
  • Principles of medical asepsis

View:

  • All skills videos pertaining to Nasogastric/Enteral Tubes made by ACC instructors
  • "Insertion and Removal of Nasogastric Tubes” --   ACC lab video (This is optional)

Additional Resources (not required):

EVC Nursing Computer Lab: Mastering Clinical Skills, GI Tubes. This is only on computers 57 and 58. Ask Mike for help.

Here is a possible complication

Complete the following exercises:

Supplemental Learning:

A good site about verification of placement

Review module objectives and check for knowledge gaps.
 

PRINT and BRING TO LAB:

  1. Word doc Check- off List from the student resources page for NGT Insertion, Suggested Sequence for NGT Irrigation, Suggested Sequence for NGT Removal, Enteral Feeding via Tube, and Administering Medication Via An Enteral Tube.
  2. Lab Review Questions
  3. Intramuscular Injection and Subcutaneous Injection check off lists from the student resources page

Complete module quiz – “Nasogastric Tube Feedings”

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