Nasogastric Tube Observation

Several factors should be considered when administering medications alongside enteral nutrition. The nurse’s main concerns in administering tube feedings and medications after receiving medical orders and feeding schedule are to check for the patient safety, monitoring for complications, comfort, and education. In fact, patient’s safety is the first concern. It’s addressed by many ways before administration of any fluids, medications, or feeding: 1) The nasogastric tube placement (through x-ray, pH testing, aspirate characteristics, external length marking, and carbon dioxide monitoring). 2) The gastric residuals every 4 to 6 hours before each feeding (know your facility policies). 3) Assessment of abdomen for abnormalities, bowel sounds at

The potential complications in administering the tube feedings and medications via enteral feeding tube are: aspiration, clogged tube, nasal erosion with nasogastric or nasointestinal tubes, diarrhea and other GI symptoms such as nausea, vomiting, distention. Unplanned extubation, and stoma infection. (Taylor 2014)

The steps to prevent those potential complications for are:

-Aspiration:

○ Use appropriate measures to check tube placement

○ Elevate head of bed at least 45 degrees during feeding and for 1 hour afterward.

○ Give small, frequent feedings.

○ Avoid oversedation of patient.

○ Check residual volume per policy.

-Clogged Tube:

○ Flush tube before and after feeding, every 4 hours during continuous feeding, and after withdrawing aspirate

○ Instill 30 mL of warm water with 50-mL or 60-mL syringe to attempt to unclog tube.

-Nasal erosion with nasogastric or nasointestinal tubes o Check nostrils every shift for signs of pressure. o Clean and moisten nares every 4 to 8 hours. o Start feeding at slow rate.

-Diarrhea

o Prevent contamination in both open and closed systems. o Change delivery set every 12 to 24 hours according to agency policy. o Refrigerate opened cans of formula and discard after 24 hours. o Limit hang time to 8 hours when using open

Removing a NG tube from the patient is the nurse’s job, but only with physician order that cannot be delegated to care techs. So after carefully removal of NGT, a nurse before giving food to patient will provide oral hygiene to take off bad odors and check the return of gagging reflex. The nurse also checks level of conscience, hunger, and diet readiness.

After the nurse receives an order to advance the diet as tolerated, tolerance of diet can be assessed by the following signs: absence of nausea, vomiting, and diarrhea; absence of feelings of fullness; absence of abdominal pain and distention; feelings of hunger; and the ability to consume at least 50% to 75% of the food on the meal tray oral nutrition.

When patient shows those signs of feeding intolerance, Nurse will perform a physical examination of the abdomen including assessment for presence of abdominal pain and bowel sounds and call the physician again. The inappropriate cessation of feeding may contribute to inadequate caloric intake and may not be physiologically