unit 8

Overview of Nasogastric Tubes, Enteral Feeding, & Ostomy Care

Quiz Information
  • Quiz #2:
    • Date: Tue, Mar 11
    • Time: 1030 - 1100
    • Lecture: 1120 - 1230
    • Location: Zoom
    • Weight: 15% of final grade
    • Format: 30 minutes, 25 questions, multiple choice and multiple response (1-5 correct answers), no partial marks for multiple response.
Quiz #1 Review
  • Modules covered:
    • Module 4: Nutrition, Mobility, and ROM
    • Module 5: Surgical Asepsis, Wound Care, Sterile Dressing Change, and Care of Surgical Drains
    • Module 6: Oxygen Therapy, Patient Safety, Adverse Events, and Restraints
    • Module 7: Complex Wounds, Skin Integrity, Pressure Injuries, Braden Scale, Pain & Comfort
  • Tips: Understand and apply content rather than just memorizing. Follow exam regulations as per the 2024-2025 U of R Undergrad Calendar.

Ostomies

  • Definition: An artificial opening created surgically in an organ.
  • Variables Affecting Ostomy:
    • Stool consistency and frequency depend on the ostomy location, diet, and hydration.
  • Types of Ostomies:
    • Colostomy: Ascending, transverse, descending, sigmoid, loop
    • Ileostomy
    • Ureterostomy
Indications for Ostomies
  1. Colon cancer
  2. Bladder cancer
  3. Gynecological or prostate cancer
  4. Crohn’s disease
  5. Ulcerative colitis
  6. Diverticulitis
  7. Bowel trauma
Ostomy Complications
  • Peristomal Issues:
    • Ischemia/Necrosis
    • Skin breakdown
    • Retraction
    • Peristomal hernia
    • Prolapse
    • Fistula
Guidelines for Ostomy Care

  1. Assess:

    • Stoma: size, shape, color, edema, bleeding
    • Stool consistency and frequency
    • Peristomal skin condition
    • Recommended equipment and supplies
    • Patient’s knowledge and comfort level

  2. Pouch Change: Every 3 to 7 days.

  3. Empty Pouch: When 1/3 to 1/2 full, remove flatus as needed.

  4. Monitor Changes: Stoma size/shape changes in first 4-6 weeks.

  5. Placement Consideration: Stoma placement in relation to incisions or scars.

  6. Patient Interaction: Address concerns, educate on nutrition/hydration, involve family.

Nutrition for Ostomates
  • Low-residue, low gas-producing diet recommended.
  • Increased chewing required for food digestion.
  • Increased water intake and electrolytes may be necessary.
Ostomy Documentation Example
  • Date: Oct 25/23, 1430
    • Emptied ileostomy bag (300mL brown liquid stool).
    • Cleaned stoma and skin with warm water.
    • Stoma measurements: 4.5 cm diameter, round, dark pink, no edema or bleeding.
    • Peristomal skin intact, with no irritation.
    • Applied a new two-piece appliance.

Enteral Feeding

  • Delivery of nutrients via tube into the GI tract (enteral feeds).
  • Indications for Enteral Feeding:
    1. Unsafe normal eating (high aspiration risk).
    2. Conditions interfering with ingestion/absorption (intestinal obstructions, surgeries, etc.).
    3. Diseases or treatments that reduce oral intake (anorexia, fatigue, etc.).
Types of Enteral Feeding Tubes
  1. Short-term:
    • Nasogastric (NG) or Orogastric (OG) tubes.
  2. Long-term:
    • Percutaneous Endoscopic Gastrostomy (PEG) tubes or Jejunostomy tubes (PEJ).
Delivery Methods for Enteral Feeding
  • Bolus: Administered like meals; short infusion time.
  • Intermittent: Given at various times; longer feeds.
  • Continuous: For critically ill patients; constant infusion.
  • Cyclical: Used at home, constant rate over 8-16 hours.
Enteral Feeding Guidelines
  1. Assess:
    • Allergies, bowel sounds, weight, fluid status, serum electrolytes, blood glucose level.
  2. Confirm Tube Placement:
    • Use X-ray or pH testing. Gastric pH ≤5 indicates correct placement.
  3. Maintain Head of Bed: Elevated at 30-45 degrees.
  4. Monitor Gastric Residual Volume (GRV):
    • Procedures for checking GRV to prevent aspiration risks.
    • If GRV >250mL, take precautions (do not start tube feed).
  5. Regular Care: Change bags/tubing per schedule and ensure tubes are flushed with sterile water.
Transitioning from Enteral to Oral Intake
  • Assess chewing and swallowing abilities.
  • Gradually progress to oral diet based on dietician's orders. Monitor food and fluid intake rigorously until needs are met.

Nasogastric (NG) Tubes

  • Indications for NG Intubation:
    • Feeding, decompression, compression, lavage, gastric analysis.
Types of NG Tubes
  • Small-bore Feeding Tube
  • Levine Tube
  • Salem Sump Tube
NG Tube Insertion Guidelines
  1. Pre-Insertion Assessment: Verify physician’s order, inspect nares, assess history (e.g., nasal surgery).
  2. Patient Positioning: Place patient in high-Fowler’s position for insertion.
  3. Insertion Procedure: Measure from tip of nose to earlobe to xiphoid process, lubricate the tube, and check placement following insertion techniques.
Checking NG Tube Placement
  • Monitor placement every 4-6 hours using:
    • X-ray (best practice)
    • Gastric pH level tests
Gastric Decompression Procedures
  • Involves tuling connected to suction to relieve abdominal distention.
  • Use concerns regarding suctioning procedures during decompression.
Possible NG Tube Complications
  1. Discomfort during insertion and while in place.
  2. Intubation into respiratory tract risks.
  3. Migratory issues with NG tube position.
  4. Tissue breakdown and pressure injuries in nares.
  5. Aspiration of gastric contents.
NG & Enteral Feed Documentation Example
  • Example dates and notes on NG tube insertion, care provided, and monitoring parameters.
References
  1. Kwiatt, M., & Kawata, M. (2013). Clinics in Colon and Rectal Surgery.
  2. Cobbett, S. L. (2024). Perry & Potter’s Canadian Clinical Nursing Skills & Techniques.
  3. Shlamovitz, G. Z. (2017). Nasogastric Intubation Technique.