ng tube feeding (Procedure Lesson Plan) (1).pptx

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1. KING GEORGE’S MEDICAL UNIVERSITY KGMU COLLEGE OF NURSING , LUCKNOW SUBJECT- CHILD HEALTH NURSING PROCEDURE OF NASOGASTRIC TUBE INSERTION AND FEEDING SUBMITTED TO : MRS SUPRIYA SINGHCLINICAL INSTRUCTOR KGMU,COLLEGE OF NURSING LUCKNOW SUBMITTED BY : AMRITA SINGH M.SC.NURSING 1 ST YEAR KGMU,COLLEGE OF NURSING LUCKNOW

2. Subject Child Health Nursing Unit / Ward Pediatric Medicine Name of the topic NG Tube insertion and IG Tube feeding Class/ group/batch B.Sc. Nursing 3 rd Year Place Pediatric Medicine ( Ward A) Date/Time 08-02-2023 Teaching Method Demonstration AV aids/ Instructional aids Lab Articles , and Dummy General objectives At the end of the procedure demonstration of NG tube feeding and insertion the students of B.Sc. Nursing will get aware of the all important aspects of the procedure. Specific objective At the end of the health education , group will be able to tell: What is Nasogastric Tube Insertion and feeding ? Purpose of NG tube insertion and Feeding. Articles required and their purpose for the procedure. Pre -procedural action of NG tube insertion and feeding. Intraprocedural actions for NG tube insertion and feeding. Post procedural steps of NG tube insertion and feeding / medication

3. S. No. Specific Objectives Time Content Method of teaching AV Aids Evaluation 1 2 3 To give the introduction of Nasogastric tube insertion process. To list down the purposes of NG tube insertion To list down the articles needed for NG tube insertion 1 Minute 1 Minute 2 Minutes NAGOGASTRIC TUBE INSERTION INTRODUCTION It is a medical process involving the insertion of a plastic tube through the nose , passing the throat and down into the stomach . PURPOSE It is used for feeding and administering drugs and other oral agents like activated charcoal. For gastric decompression and aspiration. To extract samples of gastric fluid for analysis. To feed and unconscious child . To feed sick and premature infants . To diagnose Tracheo - Esophageal Fistula. ARTICLES Nasogastric Tube Hypoallergic Tape Glass of water Lecture cum discussion Lecture Cum Discussion Lab Demonstration -------- -------- Articles Tray Describe Nasogastric Tube Insertion. Purposes of Ng tube insertion Articles needed for NG tube insertion ( Return Demonstration

4. S. No. Specific Objectives Time Content Method of teaching AV Aids Evaluation 4 To explain the steps to do before starting the exact procedure of NG tube insertion. 3 Minutes Syringe Gloves Kidney Tray Towel , Mackintosh and Drawsheet Paper bag Swab Sticks Penlight Stethoscope STEPS OF PROCEDURE PREPROCEDURAL STEPS Assess patient for the need of enteral tube insertion whether it is for feeding , aspiration or for some other purpose . Assess patient for appropriate route of insertion to evaluate nares for patency. Close each nares alternatively and ask patient to breathe for the confirmation of any obstruction in the nose. Assess for gag reflex to identify ability to swallow and risk for aspiration. Lab Demonstration Model Dummy Steps to do to before strating NG tube insertion. ( Return Demonstration)

5. S. No. Specific Objectives Time Content Method of teaching AV Aids Evaluation Inspect nares for any irritation. Review patient’s medical history for nasal problems and risk for aspiration. Review physicians order for the type and size of the tube to be inserted . There must be physician order for Ryle’s tube insertion or Ryle’s tube feeding . Bring tray with articles near patient and wash hands to reduce chances of infection. Explain procedure to the child or explain to the attendant , if the child is too small to understand .It reduces anxiety and help patient to assist in insertion. Stand on same side of the bed as nares decided for insertion and assist the child to be in comfortable position. Place small towel over chest . Keep facial tissues or wipes within reach to prevent the soiling of clothing. Determine length of the tube to be inserted and mark with tape. Method : Measure distance from tip of the nose to the ear lobe , and then to the xiphoid process of sternum.

6. S. No. Specific Objectives Time Content Method of teaching AV Aids Evaluation 5 To explain the steps of NG tube insertion procedure 5 Minutes Cut tape 10 cm long and keep ready to secure the tube. INTRAPROCEDURAL STEPS Put on clean gloves to prevent contamination from secretions. Hold the nasogastric tube 1-2 inches away from tip and lubricate the nasogastric tube with water to facilitate passage of tube into the nares to GI tract . Lubrication reduces friction between mucous membrane and the tube. Hold the head of the child and insert the tube gently by pushing the head little backward through nostrils to back of the throat. Do not forcefully insert the tube. Flex the patient’s head toward chest after tube has passed through the nasopharynx . Emphasize swallowing during the procedure to facilitates passage of tube . Swallowing closes the glottis over the trachea and facilitates the passage of tube into the esophagus. Advance the tube each time child swallows until desired length has been passed .If resistance is met or patient starts to cough , choke ,or become cyanotic , stop advancing the tube and pull the tube back.It reduces discomfort and prevents trauma. Lab Demonstration Model Dummy Steps to insert NG tube ( Return Demonstration

7. S. No. Specific Objectives Time Content Method of teaching AV Aids Evaluation Incase child is showing any sign of distress such as gasping , coughing , or cyanosis , immediately pull back the Ryle’s tube for some length and check. After some time once the child is normal re insert the tubing . Once the tube is inserted up to the marked length , any of the following methods can be used to verify placement of the tube. Aspirate the GI content with a syringe . Gastric contents are usually cloudy and grassy green or tan off-white. In contrast intestinal fluid is deep yellow and is clearer than gastric fluid. Measure pH of the aspirated GI contents. Fasting gastric pH is usually in a range of 1-4 . Intestinal pH is 7 or greater. Flush the tube with air in case of child 2ml-5ml is sufficient and simultaneously auscultate the air sound by keeping stethoscope at the lower part of xiphisternum. If sounds are present , the tube is in stomach and confirm by withdrawing air in the syringe. Another method to check the correct placement of Ryle’s tube placement is to keep the distal end of the tube in the water. If bubbles starts appearing that means the tube is in trachea and if does not appear that ensures correct placement of the Ryle’s tube.

8. S. No. Specific Objectives Time Content Method of teaching AV Aids Evaluation 6 To explain the steps have to follow after exact procedure of Ng tube insertion 2 Minutes Remove the gloves . Ryle’s tube should be fixed properly with adhesive or micropore . Obtain X-Ray film of abdomen as per hospital policies . Placement of the tube is verified by the X- Ray examination . POSTPROCEDURAL STEPS Replace equipments and wash hands . Inspect nares and oropharynx for any irritation after insertion. . Ask if patient feels comfortable. Discard the wastes . Observe patient for any difficulty in breathing or gagging .Malposition causes the symptoms written. Lab Demonstration ------- Steps to do after administration NG Tube

9. S. No. Specific Objectives Time Content Method of teaching AV Aids Evaluation 7 8 9 To introduce the NG tube insertion procedure To enumerate the purposes of NG tube feeding / medication administration To list down the articles needed for the NG tube feeding or medication 1 Minute 1 Minute 2 Minutes 2. NASOGASTRIC TUBE FEEDING INTRODUCTION It is an appropriate administered of desired strength or quantity of medicine or food through the nasogastric tube to infant child to improve their health. PURPOSE Any sick child who cannot take food orally. Premature infants who is unable to suck or swallow. Infants and children with congenital anomalies and surgery of throat or esophagus. Child with respiratory distress. Difficulty in swallowing . Unconscious child. ARTICLES Stethoscope 5 ml syringe. 20 ml-50 ml syringe to administer feed. A clean bowel A glass of drinking water to administer water. Lecture cum discussion Lecture cum discussion Lab Demonstration ------- ------ Article tray NG tube feeding process Purposes of NG tube feeding or medication Articles needed for NG tube feeding and medication ( Return Demonstration

10. S. No. Specific Objectives Time Content Method of teaching AV Aids Evaluation 10 To explain the steps to do before starting exact procedure of NG tube feeding of drug administration 3 Minutes Kidney tray or paper bag to collect waste. Food material in liquid form ( No granules should be present in any case ) Mackintosh / Towel to avoid soiling of dress or cloth. Gloves to ensure sterility to the procedure. Food or medicine ( to be administered ) with its container / strip. STEPS OF PROCEDURE PREPROCEDURAL STEPS Explain the procedure to parents and child to the level of understanding to gain confidence and cooperation. Confirm the child’s identity by asking his/her name bed number , CR number and age. Give comfortable position to the child . Arrange the articles in tray. Verify the order on the patients treatment record by checking it against the doctors’ order Lab Demonstration Model Dummy Steps to do before NG tube feeding / medication ( Return Demonstration

11. S. No. Specific Objectives Time Content Method of teaching AV Aids Evaluation 11 12 To demonstrate the steps of NG tube feeding or medication To demonstrate the process of preparing tablets and capsules 3 Minutes *3 Minutes INTRAPROCEDURAL STEPS Wash hands as it reduces transfer of microorganisms to food , medicine , equipments as well as patients. Bring trolley with the articles near the patient on right side , same time . Read the physician’s order and compare it with intake output chart / mediation card. Check 7 rights in case of administration of medication. After reading the intake output chart or medicine card take appropriate amount of food or medicine. (Food content should not have any granule particle .) Compare the medicine label with medication card , check for the expiry date . Take appropriate amount of food to be administered Calculate the dose and measure the medication to be administered .Take time and double check calculation of doses to ensure accuracy . PREPARATION OF TABLETS AND CAPSULES Place packaged until dose capsules or tablets from bottle or strip directly into the medicine cup , do not touch with finger to prevent transfer of the microorganisms Lab Demonstration Lab Demonstration Model Dummy Articles tray Steps of NG tube feeding /insertion ( Return Demonstration Method of preparing tablets and capsules for medication through NG tube

12. S. No. Specific Objectives Time Content Method of teaching AV Aids Evaluation 13 To demonstrate the process of preparing liquid or syrup medication *3 Minutes Crush the tablet with mortar and pestle to a fine powder. Dissolve it in calculated amount of water . PREPARATION OF LIQUID OR SYRUP Thoroughly shake bottle and mix the medicine in the bottle. Remove the cap and take medicine in to it. Hold the bottle so that label is next to palm and pour the medication away from the palm to prevent spoilage of the label. Hold the medication cup at the eye level and fill it to desired level for accurate measurement. Use syringe for measuring medication if the dose is in fraction to ensure efficacy. Wipe mouth of the bottle with cotton and label ‘will not be soiled with spilled liquid’ Spread mackintosh / small towel o the chest of the patient to protect the child and bed linens from any spills with medicine or vomit. Administration of drug through nasogastric tube. Lab Demonstration Articles tray Method of preparing liquid / syrup for medication through NG tube

13. S. No. Specific Objectives Time Content Method of teaching AV Aids Evaluation 14 To demonstrate the steps of NG tube feeding or medication 3 Minutes Do not leave the drug unattended. Assess the patient's abdomen for bowel sounds and distention, check abdominal girth before each feed. Perform necessary pre-administration assessment for specific medication i.e. vital signs Elevate the bed to semi or high Fowler's position to promote digestion. Check tube patency and positions (aspirate stomach contents). Withhold feeding/medication, if residual volume is greater than the required amount of feed. Hold the nasogastric tube somewhat above the level of the patient's nose. Check the aspirate before procedure. ADMINISTRATION OF DRUG THROUGH RT Identify child by comparing name on medicine card with the name child gives when asking third check of label to reduce errors. Remove the plunger from the syringe and connect it to pinched or kinked feeding tube. Lab Demonstration Articles tray and lab dummy Procedure of NG tube feeding and drug administration ( Return Demonstration

14. S. No. Specific Objectives Time Content Method of teaching AV Aids Evaluation Pinching of tube prevents air to enter into the tube. Pinch the feeding tube and fill with 5 mL of water into the syringe barrel before administering the first medication. It prevents the interaction of medication with the previous feed of medicine content in the tube. Hold the tube with one hand , release the tubing and elevate the syringe barrel to allow liquid to flow by gravity. Then liquid or dissolve medication into syringe barrel and allow to flow by gravity into enteral tube. To prevent air entering in the tube and child’s stomach never allow to the syringe to empty completely .Always administer a tube feeding slowly tube feeding slowly. If you are administering several medication then administer each one separately and flush with at least 5 mL of water between each medication (if fluid restriction is not there) to prevent the drug interaction. After administering the appropriate amount of feed/medications, flush the tube with 5-10 mL of water and close the tube. If child is on continuous aspiration clamp the tube for 20-30 minutes after giving medication for absorption.

15. S. No. Specific Objectives Time Content Method of teaching AV Aids Evaluation 15 To explain the steps have to follow after exact procedure of NG tube feeding or medication through it 2 Minutes Document the medication/amount of feeding given and how tolerated on child's treatment chart and intake-output chart . POSTPROCEDURAL STEPS Return intake out out chart /medication chart to appropriate folder for next time use. Take all the articles to treatment room. Wash and dry all the articles and replace them in the students cupboard. Wash hands, clean work area. Return to the patient to check for any expected or unexpected reactions after administration of food specially medication. Lab Demonstration ------ Steps to do after completing NG tube feeding or medication through NG tube

16. SUMMARY Nasogastric tube insertion means insertion of tube from nares to oropharynx to stomach for different purposes for example feeding an unconscious child , child with swallowing difficulty ,unhealthy newborn , medication purpose , analysis of gastric contents etc. alot of articles are needed for NG tube insertion and feeding . NG tubes of different size comes for different age group of the child. Various preprocedural , Intraprocedural and post procedural steps we are suppose to do for NG tube insertion and NG tube feeding. While doing the procedure we need to ensure that the tube goes easily through nares to oropharynx to stomach with use of any extra force. In case child is showing any contraindication immediate action need to be taken for that.Proper documentation of the procedure should be done for future referene of the same procedure.

17. CONCLUSION NG tube insertion and NG Tube feeding and NG tube insertion has come out to be one of the most effective method of provding nutrition and medication to a newborn or child who is unable to take it through oral route . Appropriate size of NG tube must be us to avoid any contraindication of the procedure.Maintaining clean technique ensures prevention of crossi nfection . Doing this procedure in right way can bring a lot of improvement in the health status of the child while doing significant errors might bring serious complication in the condition of the child.So being a professional health care provider we have to be very much skilled in doing the procedure with minimal or no significant mistakes. In such a way we can fulfill the actual goal of this procedure.

18. BIBLIOGRAPHY Rana kaur avinash , et al ‘ CLINICAL NURSING PROCEDURES ’ 2 nd edition , CBS publishers pvt .ltd . Pp 926-929 ,976-978 https://medlineplus.gov/ency/patientinstructions/000182.htm https://youtu.be/k8aH0TyJYhc .