exam review 1.

NG Tube Insertion Steps

• Verify Orders

  • Check original physician's order for the type of NG tube and its attachment (suction or drainage)

• Client Assessment

  • Have client close each nostril alternately and breathe to assess nostril patency

  • Examine each naris for any skin breakdown

  • Assess mental status, gag and cough reflexes, swallowing ability, critical condition, and presence of an artificial airway

  • Perform an abdominal assessment for bowel sounds, pain, tenderness, or distention

  • Identify the client using two identifiers

• Preparation

  • Perform hand hygiene

  • Position client in high Fowler's position unless contraindicated

  • Measure the length of the tube (tip of nose to earlobe to xiphoid process), marking with tape

• Prepare NG Tube for Intubation

  • Inject 10 ml of water into the NG tube to ensure patentness

  • Wear clean gloves

  • Stand to the right of the client if right-handed, or the left if left-handed

  • Curve the end of the tube tightly around the index finger (10-15 cm or 4-6 inches) to reduce stiffness

  • Lubricate 7.5 to 10 cm (3-4 inches) of the tube end with water-soluble lubricant

  • Explain the procedure to the client and instruct them to extend their neck back against the pillow

• Insertion Process

  • Insert tube gently through the naris with the curved end pointing downwards

  • Advance along the floor of the nasal passage toward the ear

  • Apply gentle pressure to advance if resistance occurs but do not force it

  • If resistance persists, rotate the tube and try re-inserting; if still resistant, withdraw and try the other naris

  • Once past the nasopharynx, allow the client to relax and explain that the client must swallow during the next steps

  • Offer a glass of water (unless contraindicated) and instruct the client to flex their head forward, sip, and swallow as you advance the tube 2.5-5 cm (1-2 inches) with each swallow

• Adjusting the Tube

  • If the client coughs, gag, or chokes, withdraw slightly and stop advancement

  • Allow client to breathe and sip water

  • If tube coils in the oropharynx, check and reinsert while the client swallows

  • Continue advancing until reaching the marking on the tube that indicates the desired distance

• Anchoring the Tube

  • Temporarily anchor the tube to the cheek with tape until placement is verified

Checking Placement and Residual of NG Tube

• Policies

  • Follow agency policies for verifying tube placement

• Verification Techniques

  • Ask the client to speak; inability to talk indicates tube passing through vocal cords

  • Inspect the posterior pharynx for coiled tubes

  • Place towel under the tube end and attach a syringe; aspirate gently for gastric contents and observe color

  • Use pH paper to check aspirate for gastric pH (should be 1.0-11.0)

• X-ray Verification

  • Obtain x-ray as ordered if tube placement is in question

  • If initial placement is not confirmed, advance another 2.5-5 cm (1-2 inches) and repeat verification

  • Anchor the tube securely once placement is verified

• Patient Positioning and Care

  • Always place the patient in high Fowler's position before administering feeds or medications

  • Large aspirates may indicate delayed gastric emptying; this can lead to distress and vomiting

  • Flush with 30-60 ml of room temperature water post-administering medication/feeds to prevent blockage

  • Document tube placement verification, residual amount and color, feed dates/times, responses, water amount administered, any adverse effects, and nurse's initials/signature

Foley Catheter Insertion Procedure Steps

• Pre-Insertion Preparations

  • Verify physician orders and gather supplies

  • Knock, introduce yourself, and ensure privacy

  • Explain the procedure and verify allergies (latex, iodine)

  • Raise the bed to a comfortable height and assess client's last void

• Client Positioning and Initial Steps

  • Don clean gloves and palpate for bladder fullness

  • Provide perineal care if necessary

  • Position client in dorsal recumbent or supine with thighs abducted; lower side rails

  • Promote client involvement

• Sterile Procedure Setup

  • Remove gloves and wash hands

  • Open catheter kit using sterile technique; place sterile drape between legs

  • Don sterile gloves, set up field, and attach a 10 ml syringe to the catheter (do NOT inflate balloon yet)

  • Lubricate the catheter tip and prepare antiseptic swabs

• Insertion Technique

  • MALE: Hold penis at 60-90 degree angle and cleanse from meatus outward in circular motion (3 swabs)

  • FEMALE: Spread labia to view meatus; cleanse area, starting from labia to meatus with new swabs each time

  • Insert the catheter into the urethra until urine is noted (6-7 inches for males, 2-4 inches for females); advance an extra 1-2 inches for females after initial urine stream

  • Inflate catheter balloon and disconnect syringe; gently pull back until resistance is felt; return foreskin if applicable

  • Secure the catheter to the thigh and document details post-insertion

Bladder Training Overview

• Definition and Purpose

  • A behavioral therapy to improve bladder control and reduce incontinence

  • Involves gradually increasing intervals between urination to allow the bladder to hold more

• Implementation Steps

  • Track urination frequency and amount

  • Establish a schedule for urination

  • Encourage complete bladder emptying

Fluid and Electrolyte Management

• Fluid Outputs

  • Aldosterone regulates Na+ and water excretion; ADH regulates water excretion

  • Minimum urine output necessary: 30ml/hr

  • Best water balance indicator: daily weights

  • Insensible fluid loss mainly occurs via respiration and sweat

• Hypervolemia (Fluid Excess)

  • Causes: Liver disease, renal damage, excessive salt intake, SIDAH

  • Symptoms: N/V, headache, confusion; untreated can lead to hyponatremia and coma

  • Treatment: Focus on excess fluid removal

• Hypovolemia (Dehydration)

  • Causes: Fever, heat exposure, vomiting, diuretics, lack of drinking water

  • Symptoms: Poor skin turgor, thirst, confusion; may lead to hypotension and reduced urine output

  • Treatment: Fluid resuscitation

• Electrolyte Overview

  • Electrolytes: charged particles in water (Na+, K+, Ca++, Mg++)

• Hyperkalemia (High Potassium)

  • Normal range: 3.5 – 5; Levels above indicate hyperkalemia

  • Causes: kidney failure, RBC destruction, potassium supplements

  • Symptoms: muscle fatigue, hypotension, arrhythmias

  • Treatment: Monitor cardiovascular, renal, GI status; administer diuretics

• Hypokalemia (Low Potassium)

  • Levels below 3.5; Causes: diarrhea, vomiting, alcohol use

  • Symptoms: weakness, constipation, arrhythmias

  • Treatment: potassium supplements or IV administration

• Hyponatremia and Hypernatremia

  • Hyponatremia: Levels below 135; caused by inadequate intake, fluid overload, symptoms include headache, confusion

  • Hypernatremia: Levels above 145; caused by dehydration, symptoms include dry mucous membranes, confusion

• Magnesium (Mg++) Levels

  • Normal: 1.5 – 2.5; hypermagnesemia above 2.5 can cause cardiac issues

• Calcium (Ca++) Levels

  • Normal: 8-10; Hypercalcemia above 10 causes symptoms like confusion and lethargy

  • Hypocalcemia below 8 demonstrates symptoms such as anxiety and muscle spasms

Acid-Base Balance

• Importance of pH Homeostasis

  • Ideal ratio: 1 part carbonic acid to 20 parts bicarbonate

  • Body systems involved include blood buffers, lungs, and kidneys

• ABG Normal Values

  • pH: 7.35 – 7.45; PaCO2: 35 – 45 mm Hg; PaO2: 80 – 100 mm Hg

• Types of Imbalances

  • Respiratory acidosis/alkalosis, metabolic acidosis/alkalosis

  • Respiratory acidosis: Low pH with increased CO2; signs include headache, hypoventilation

  • Respiratory alkalosis: High pH with decreased CO2; symptoms include hyperventilation

  • Metabolic acidosis: Low pH with decreased bicarbonate; symptoms include nausea and muscle twitching

  • Metabolic alkalosis: High pH with increased bicarbonate; symptoms include confusion and tremors

Overview of Lung Conditions

• Pneumonia

  • Inflammation of airspaces due to infection or aspiration; symptoms include cough, fever

  • Treated with CXR, ABG’s, antibiotics

• Emphysema & Chronic Bronchitis

  • Causes: smoking and pollution; symptoms include dyspnea and productive cough

  • Treated via pulmonary function tests, bronchodilators

Clean Catch Urine Sample

• Procedure

  • Wipe from front to back, urinate in toilet before collecting sample in sterile cup

Lung Cancer Overview

• Types: Non-small cell and small cell lung cancer

• Risk Factors: Smoking, family history, occupational exposure

• Symptoms: Persistent cough, hemoptysis, unexplained weight loss

Treatment Options for Lung Cancer**

• Surgery: Lobectomy, pneumonectomy

• Chemotherapy/Targeted Therapy: For advanced cases

Assessment of Patients with Cancer**

• Patient History: Evaluate pain, fatigue, weight changes, respiratory symptoms

• Physical Examination: Assess general appearance, vital signs, systemic systems

Conclusion**

• Comprehensive cancer assessment addresses physical and emotional health; guides symptom management and patient care.