Care of patient with Pain (Fundamentals of Nursing)

FON (therapeutic care) BSc(N)

1. Care of patient with Pain.

2. Care of patient with Naso -gastric tube

3. Naso-gastric suction: Nasogastric (NG) intubation  is a procedure in which a thin, plastic tube is inserted into the nostril, toward the esophagus, and down into the stomach . NG tubes are usually short and are used mostly for suctioning stomach contents and secretions . here are various tubes used in GI intubation but the following two are the most common: Levin tube.  Is a single-lumen multipurpose plastic tube that is commonly used in NG intubation. Salem sump tube.  A double-lumen tube with a “pigtail” used for intermittent or continuous suction.

4. Nursing Management: The following are the nursing considerations you should watch out for: Provide oral and skin care.  Give mouth rinses and apply lubricant to the patient’s lips and nostril. Using a water-soluble lubricant, lubricate the catheter until where it touches the nostrils because the client’s nose may become irritated and dry. Verify NG tube placement.  Always verify if the NG tube placed is in the stomach by aspirating a small amount of stomach contents. An X-ray study is the best way to verify placement. Wear gloves.  Gloves must always be worn while starting an NG because potential contact with the patient’s blood or body fluids increases especially with inexperienced operator. Face and eye protection.  On the other hand, face and eye protection may also be considered if the risk for vomiting is high. Trauma protocol calls for all team members to wear gloves, face and eye protection and gowns.

5. Naso-gastric Irrigation: A nasogastric tube is irrigated regularly to determine and ensure the tube’s patency. It will help release any formula stuck to the inside of the tube . Objective To ensure the patency of the nasogastric tube. Indication Stomach contents fail to flow through tube .

6. Steps in Irrigating Nasogastric Tubes The following is the step-by-step procedure in irrigating nasogastric tubes: 1 Check physician’s order for irrigation. Explain procedure to client.  Clarifies schedule and irrigating solution. An explanation encourages client cooperation and reduces apprehension. 2 Gather necessary equipment. Check expiration dates on irrigating saline and irrigation set.  Provides for organized approached to task. Agency policy dictates safe interval for reuse of equipment. 3 Wash your hands.  Handwashing  deters the spread of microorganisms. 4  Assist client to semi-Fowler’s position unless this is contraindicated.  Minimizes risk of aspiration.

7. Cont… 5 Check placement of NG tube using the following techniques:  A . Attach Asepto or Toomey syringe to the end of tube and aspirate gastric contents.  The tube is in the stomach if its contents can be aspirated. B . Place 10mL-50ml of air in syringe and inject into the tube. Simultaneously, auscultate over the epigastric area with a stethoscope.  A whooshing sound can be heard when the air enters the stomach through the tube. C . Ask client to speak.  If tube is misplaced in trachea, client will not be able to speak. 6 Clamp suction tubing near connection site. Disconnect NG tube from suction apparatus and lay on disposable pad or towel.  Protects client from leakage of NG drainage. 7 Pour irrigating solution into container. Draw up 30 ml of saline (or amount ordered by physician) into syringe.  Delivers measured amount of irrigant through NG tube. Saline compensates for electrolytes lost through NG drainage.

8. Cont… 8 Place tip of syringe in NG tube. Hold syringe upright and gently insert the irrigant (or allow solution to flow in by gravity if agency or physician indicates). Do not force solution into NG tube.  Position of syringe prevents entry of air into stomach. Gentle insertion of saline (or gravity insertion) is less traumatic to gastric mucosa. 9 If unable to irrigate tube, reposition client and attempt irrigation again. Check with physician if repeated attempts to irrigate tube fail.  Tube may be positioned against gastric mucosa making it difficult to irrigate. 10 Withdraw or aspirate fluid into syringe. If no return, inject 20 ml of air and aspirate again.  Injection of air may reposition the end of tube. 11 Reconnect NG tube to suction. Observe movement of solution or drainage.  Determine patency of NG tube and correct operation of suction apparatus.

9. Cont… 12 Measure and record amount and description of irrigant and return solution.  Irrigant placed in NG tube is considered intake: solution returned is recorded as output. 13 Rinse equipment if it will be reused.  Promotes cleanliness and prepares equipment for next irrigation. 14 Wash your hands.  Handwashing deters the spread of microorganisms. 15 Record irrigation procedure, description of drainage and client’s response.  Facilitates documentation of procedure and provides for comprehensive care.

10. GASTRIC ANALYSIS  General  Examination of gastric contents and gastric juice provides information used in diagnosis. For example, the following may be determined: (1) The presence, amount, or absence of hydrochloric acid. (2) The presence of cancer cells. (3) The types and amounts of enzymes present.

11. Pre-Procedural Nursing Implications.  (1 ) The patient must be educated about the procedure, the significance of the preparation, and any significant post-procedural sequelae. (2) Many procedures require that the patient sign a permit. Check with your local MTF SOP. (3) The physician may require the patient to be nothing by mouth ( NPO) for 8-10 hours prior to the test. (4) Gastric analysis requires the insertion of a gastric tube for the purpose of withdrawing a specimen. General care and precautions associated with gastric intubation should be implemented. (Refer to Section IV, Gastrointestinal Intubation.) (5) If ordered by the physician, withdraw the stomach contents and save for lab analysis. (6) The patient should be allowed to rest for 20 to 30 minutes after insertion of the tube before beginning the test. This allows time for the patient’s body to return to a rested, basal state.

12. Procedural Nursing Implications.  (1) Obtain the specimens as directed by the physician or local SOP. (2) Label each specimen with the amount and the time collected in addition to the patient identification. (3) Note and report the presence of the following: Undigested food. Blood. Fecal odor. (4) Assess the patient’s tolerance to the procedure by monitoring blood pressure and pulse. (5) Some gastric analysis tests require the administration of drugs to stimulate gastric secretion. It is necessary to have an emergency cart available in these cases.

13. Post-Procedural Nursing Implications . ( 1 ) Monitor the patient’s vital signs in accordance with the ward’s SOP. (2) Observe for signs of throat irritation secondary to tube placement. (3) Observe for signs of bleeding from the throat or stomach. (4) Resume diet and medication IAW the physician’s orders or ward SOP.