Nursing English Modul
Akes Karya Husada Yogyakarta
BOOK 1
JOGJAKARTA 2014
CONTENT OF BOOK 1
1.
Chapter 1
Hospital
department............................................................................................... 2
2.
Chapter 2
Physical examination equipment............................................................................. 6
3.
Chapter 3
PART OF THE BODY.................................................................................................. 9
4.
Chapter 4
VITAL
SIGN............................................................................................................. 11
5.
Chapter 5
MEDICATION ADMINISTRATION............................................................................. 15
6.
Chapter 6
INSERTION OF AN INTRAVENOUS CANNULA........................................................... 17
7.
Chapter 7
OXYGEN THERAPY.................................................................................................. 20
8.
Chapter 8
SAMPLING FOR INVESTIGATION.............................................................................
22
9.
Chapter 9
INSERTION
OF NASOGASTRIC TUBE........................................................................ 24
DAILY
ENGLISH AND NURSING VOCABULARY
CHAPTER
1
HOSPITAL DEPARTMENT
Ø Main emergency department.
a.
Triage
b.
CPR (cardio
pulmonary resucitation) room
c.
Administration
desk & admission office
d.
Examination
room
e.
Observation
room
f.
Treatment room
g.
Minor surgery
IN
PATIENT DEPARTMENT :
Ø Surgical department.
a.
General surgery
ward
b.
ENT (ear nose
throat) ward
c.
Urology ward
d.
Plastic surgery
ward
e.
Neuro surgery
ward
f.
Chest surgery
ward
g.
Burn unit
h.
Orthopedic ward
Ø Medical department.
Ø Pediatric department
Ø Physiatric department
Ø Maternity department.
a.
Labour room
b.
Delivery room
c.
Antenatal care
Ø ICU( INTENSIVE CARE UNIT)
a.
CCU (coronary
care unit)
b.
SICU (surgical
intensive care unit)
c.
NICU (neonatal
intensive care unit)
d.
PICU (pediatric
intensive care unit)
Ø OT (operating theatre)
a.
OT reception
b.
Anaesthetist
room
c.
Operating room
d.
Recovery room
Ø Nephrology department
-
Aku (artificial
kidney unit)
a.
Haemodialysis unit
b.
Peritonial
dialysis unit
OUT PATIENT DEPARTMENT
-
Out patient
clinic
-
Appointment department
-
Admission
office department
-
CSSD(central
sterile supply department)
-
Mortuary
department
-
Dietary
department
-
Social worker
department
-
forensic
department
-
Laundry
department
-
Medical record
department
-
Stock, supply
department
-
Pharmacy
Ø Maternity department, labour room, neonatal ward.
Ø Radiologist department,
a.
X-ray
b.
CT-scan computed
tomography
c.
MRI magnetic
resonance imaging
d.
Endoscopy , colonoscopy ,ERCP (endoscopic retrograde cholangiopancreatography)
e.
Nuclear
medicine.
f.
Angiogram room
g.
U/S Ultrasound
room
VOCARABULY
DIRECTION
1.
LEFT
2.
RIGHT
3.
TURN
4.
ONE WAY
5.
U-TURN
6.
CORRIDOR
7.
CORNER
8.
FLOOR
9.
STAIR
10.
UP STAIR
11.
DOWN STAIR
12.
ELEVATOR
13.
EMERGENCY EXIT
14.
GATE
15.
VISITOR
16.
VISITING TIME
17.
WATCHER, ATTENDED
18.
OPPOSITE OF
19.
NEXT TO
20.
ACROSS FROM
EXPRESSION ASKING GIVING
DERCTION
Ø HOW TO ASK FOR
DIRECTION
1.
Could You Tell
Me How To Get To Medical Word.
2.
Can You Tell Me
Where.................Is?
3.
Iam Looking For
Radiologist Department
Ø EXPRESSION TO
GIVE SIMPLE DERECTION
1.
Medical Word Is
Located In 2nd Floor
2.
Radiologist Is
Near To Emergency Department
3.
Go Up Stairs
4.
Then Turn Left/
Right
5.
Go Along
.......
6.
Go Stright
7.
Surgical
Department Is Just Before The Plaster
Room
8.
Ent Word Is
Just After The Long Corridor
CONVERSATION FOR ASKING AND GIVING
DERECTIONS
|
Name
|
Conversation
|
|
Security
|
Good Evening Sir, May I Help You?
|
|
Visitor
|
Good Evening Too Sir, I Want To
Visite My Friend He Has Been
Admitted In This Hospital
|
|
Security
|
Could You Tell Me The Complete Name Of Your Friend
|
|
Visitor
|
His Name Is, ..... He Gor Rta Yesterday Night
|
|
Security
|
He Is Admitted In Neuro Surgical Ward, Room Number.
|
|
Visitor
|
Could You Tell Me How To Get
To Neuro Surgical Ward
|
|
Security
|
Sure ,,,, Just Go To Up Stair
I N The First Floor.
|
|
Visitor
|
Thank You Very Much
|
CHAPTER 2
Physical
examination equipment
-
Stetoscope
-
Blood pressure
equipment
a.
Manual blood
pressure tool
b.
Digital blood
pressure
-
Thermometer
a.
Manual
b.
Digital
-
Pulse oxymeter
-
Hammer
-
Pen light
-
Opthalmoscope
-
Otoscope
-
Weight and hight scale
-
Glucometer
Ø SYRINGE
-
Heparin syringe
1 ml
-
Insulin syringe
1 ml
-
2ml, 5ml, 10
ml, 20 ml, 50 ml, asepto syringe for feeding
Ø MEDICATION
-
Medication tray
-
Medication cup
-
Medication
cutter
-
Medication
crusher
-
Medication
label
-
Medication
trolley
-
Medication
chart
Ø Ward equpment
-
Patient bed
a.
Bed
b.
Matress
c.
Side rail
d.
Bed controller
e.
Bed lock
f.
IV stand
g.
Bedside table
h.
CPR board on
head of bed
i.
Pillow,bed
sheet,blanket,bed cover
j.
Calling bel
k.
Air matress
l.
Bed warmer
m.
Slide pad
-
Wheel chair
-
Stretcher
-
Oygen cylinder
-
Suction machine
(portable and manual )
-
Crash cart(defibrilator,
ambubag, laringoscope, ET tube and emergency medicine)
-
ECG machine
-
Echo cardiogram
machine
-
Infusion pump
-
Syringe pump
-
PCA machine
(patient controlled analgesia)
-
Cardiac monitor
-
ABG machine
(arterial blood gas)
-
Urine analysis
-
Ventilator
machine
-
Anti DVT pump
(deep vein thrombosis)
-
Cryocuff
-
Immobilizer
-
Nebulizer
machine
-
Cruthes
CHAPTER 3
PART OF THE BODY
General veins
CHAPTER 4
VITAL SIGN
Reflect the function of three body
processes that are essential for life.
–
Regulation of body temperature
–
Heart function
–
Breathing
Objectives
Explain the
meaning of vital signs and the abbreviations used for each vital sign.
•
Abbreviations:
–
Temperature – T
–
Pulse – P
–
Respirations – R
–
Blood Pressure – BP
–
Vital signs - TPR and BP
•
Purpose
–
Measured to detect any changes in normal body
function
–
Used to determine response to treatment
•
Measurement (taken at rest)
–
Temperature - measures body heat
–
Pulse - measures heart rate
–
Respiration - measures how often resident
inhales and exhales
–
Blood Pressure - measures pressure against walls
of arteries
Temperature
– Measurement Of Body Heat
•
Heat production
–
muscles
–
glands
oxidation of
food
•
Heat loss
–
respiration
–
perspiration
–
excretion
Balance
between heat production and heat loss is body temperature
Factors
Affecting Temperature
•
Exercise
•
Illness
•
Age
•
Time of day
•
Medications
•
Infection
•
Emotions
•
Hydration
•
Clothing
•
Environmental temperature/air movement
Equipment - Thermometer
•
Types
-
chemically treated paper – disposable
-
plastic – disposable
-
electronic - probe covered with disposable
shield
-
tympanic - electronic probe used in the ear
Normal
Temperature Range For Adults
•
Oral - 97.6°
- 99.6° F (Fahrenheit) or 36.5° -37.5° C (Celsius)
•
Rectal - 98.6°
- 100.6° F or
37.0° - 38.1° C
•
Axillary - 96.6°
- 98.6° F or 36.0° - 37.0° C
Sites
To Take A Temperature
•
Oral – most common
•
Rectal – registers one degree Fahrenheit higher
than oral
•
Axillary – least accurate; registers one degree
Fahrenheit lower than oral
•
Tympanic – probe inserted into the ear canal
Condition of resident determines
which is the best site for measuring body temperature
Measurement of Pulse
•
Pulse is pressure of blood pushing against wall
of artery as heart beats and rests
•
Pulse easier to locate in arteries close to skin
that can be pressed against bone
Sites For Taking Pulse
•
Radial – base of thumb
•
Temporal – side of forehead
•
Carotid – side of neck
•
Brachial
– inner aspect of elbow
Brachial
– inner aspect of elbow
•
Femoral – inner aspect of upper thigh
•
Popliteal - behind knee
•
Dorsalis pedis – top of foot
•
Apical pulse – over apex of heart
-
taken with stethoscope
-
left side of chest
Factors Affecting Pulse
•
Age
•
Sex
•
Position
•
Drugs
•
Illness
•
Emotions
•
Activity level
•
Temperature
•
Physical training
Measurement of Pulse
•
Normal pulse range/characteristics: 60 -100 beats per minute and regular
•
Documenting pulse rate
–
Noted as number of beats per minute
–
Rhythm - regular or irregular
–
Volume - strong, weak, thread, bounding
Measuring Respirations
•
Respiration – process of taking in oxygen and
expelling carbon dioxide from lungs and respiratory tract
Factors Affecting Rate
•
Age
•
Activity level
•
Position
•
Drugs
•
Sex
•
Illness
•
Emotions
•
Temperature
•
Qualities of normal respirations
-
12-20 respirations per minute
-
Quiet
-
Effortless
-
Regular
•
Documenting respiratory rate
-
Noted as number of inhalations and exhalations
per minute (one inhalation and one exhalation equals one respiration)
-
Rhythm – regular or irregular
-
Character:
shallow, deep, labored
Measuring Blood Pressure
•
Blood pressure is the force of blood pushing
against walls of arteries
–
Systolic pressure: greatest force exerted when
heart contracting
–
Diastolic pressure: least force exerted as heart
relaxes
Factors Influencing Blood
Pressure
•
Weight
•
Sleep
•
Age
•
Emotions
•
Sex
•
Heredity
•
Viscosity of blood
•
Illness/Disease
Blood Pressure: Equipment
•
Sphygmomanometer (manual)
–
cuff - different sizes
–
pressure control bulb
–
pressure gauge – marked with numbers
ü aneroid
ü mercury
•
Stethoscope
–
magnifies sound
–
has diaphragm
Measuring Blood Pressure
•
Normal blood pressure range
–
Systolic:
90-140 millimeters of mercury
–
Diastolic:
60-90 millimeters of mercury
Guidelines
for Blood Pressure Measurements
•
Measure on upper arm
•
Have correct size cuff
•
Identify brachial artery for correct placement
of stethoscope
•
First sound heard – systolic pressure
•
Last sound heard or change - diastolic pressure
•
Record - systolic/diastolic
•
Resident in relaxed position, sitting or lying
down
•
Blood pressure usually taken in left arm
•
Do not measure blood pressure in arm with IV,
A-V shunt (dialysis), cast, wound, or sore
•
Apply cuff to bare upper arm, not over clothing
•
Room quiet so blood pressure can be heard
•
Sphygmomanometer must be clearly visible
Blood
Pressure: Reading Gauge
•
Large lines are at increments of 10 mmHg
•
Shorter lines at 2 mm intervals
•
Take reading at closest line
•
Gauge should be at eye level
•
Mercury column gauge must not be tilted
•
Reading taken from top of column of mercury
CHAPTER 5
MEDICATION
ADMINISTRATION
A.
SAFETY
RULE.
1. Right Drug
2. Right Dose
3. Right Route
4. Right Patient
5. Right Time
6. Right Documentation
B.
NURSE
RESPONSIBILITY
Only register nurse or a Doctor may administer
medication before the giving medication, nurse must be aware of:
1. Patient diagnosis
2. Drug Allergy
3. Effect of the Drug
4. Dose and route of medication
5. Expire date of medication
6. Action of the Drug
-
Identify the patient by calling the complete name.
-
Report immediately to the doctor if there is any reaction from the drug.
-
If patient refused for medication, report to the doctor.
-
If we cannot understand or read the doctor order, we have to ask.
C.
ROUTE OF
MEDICATION
1. ORAL ROUTE
A. Medication to be
placed on mucus membrane
B. Sublingual medication / S L: medication to be placed under the tongue
C. By swallowing
2. RECTAL ROUTE
A. Suppository
B. Liquid (retention enema)
3. OTHER ROUTE
A. Inhalation route
B. NGT route
C. Topical route
D. Eye, Nose, Ear route
E. Vaginal route
D.
MEDICATION
ORDER
Definition: Order inside
hospital written by doctor in order in the file or patient’s chart.
Drug order should consist of seven parts.
1. Patient’s name
2. Date the drug was ordered
3. Drug’s name
4. Dosage
5. Route of administration and any special route of administration
6. Time and frequency
7. Signature of the individual who ordered
E.
INJECTION
TECHNIQUE
If more than one medication is ordered
for injection, we must do separated injection / syringe should be used for one
drug only. This is to prevent any chemical reaction between two drugs being
mixed in one syringe.
The exception to this rule is vitamin
B12 and folic acid; these two medications may be mixed in one syringe and given
as one injection.
1.
INTRAVENOUS
INJECTION (25’)
IV
injection is medication directed in to the vein. The action of drug is very
fast. Drug must be given slowly and
usually in diluted.
2.
INTRA
DERMAL (Intracutoneus) 10 – 15̊
Intracutaneus
is injection medication in to the dermis layer. There are two best sides for giving intracutaneus injection:
Inner for
arm :
For example for Mantoux test
Upper back
or scapular area : Never used
3.
SUBCUTANEUS
( S.C)
SC
injection is injection medication in to the loose connective tissue
underlying dermis or the fatty layer
under skin; there are 5 sides for giving SC injection
1.
Upper arm or deltoid
2.
Abdomen or at navel
Abdomen or at navel
3.
Thing or vastus lateralis
4.
Hip or
ventrogluteal
5.
Upper back or scapular area
4.
INTRA
MUSCULAR
IM
injections injection medication in to
deep
muscle tissue.
There are
4 best sides to give
1.
Thing (
Vastus lateralis)
2.
Hip
( Ventrogluteal)
3.
Buttock
( Dorsogluteal )
4.
Upper arm (
Deltoid )
CHAPTER 6
INSERTION
OF AN INTRAVENOUS CANNULA
Standard
1.
List the indication for insertion of an
intravenous cannula
-
Administration of medication in bolus or
continuous / intermittent infusion
-
Administration of fluid and electrolyte
for patient with electrolyte Imbalances,
malnutrition, shock, trauma, sepsis, surgery, endocrine
disorders, cardiovascular disease and cancer
-
Administration of blood and blood products.
-
For diagnostic procedure
2.
List the
most commonly used veins for peripheral IV cannula insertion :
-
Cephalic
-
Basilic
-
Median veins in the lower arm
-
Metacarpal veins in the dorsum of the hand
3.
Verbalizes the factor which help to maintain the
iv therapy longer.
-
Select most distal site of the extremity
-
Use smallest gauge catheter appropriate to vein
size and prescribed therapy
-
Avoid area of flexion such as antecubital fossa
and the wrist
-
Use the non dominant hand
-
Choose the site that are located above previous
insertion sites and sites that phlebitis, infiltrated or bruised.
4.
Describes the most commonly used of types of IV
cannula used for peripheral intravenous
insertion.
-
Over the needle ,plastic catheter in different
sizes (27G to 12G) for short term IV therapy (7days or less)
-
The winged infusion set or “Butterfly” for less
than 24 hours
5.
Lists the complications associated with the
insertion of a peripheral IV cannula.
a.
Local
-
Phlebitis
-
Thrombo Phlebitis
-
Infiltration
-
Catheter occlusion
b.
Systemic
-
Septicemia
-
Thrombo embolism
-
Embolism
-
Circulatory overload
-
Speed shock
-
Allergic/anaphylactic reaction
Technical in insertion of an intravenous
cannula
1.
Check the physician order for the following :
-
Name, Dose ,frequency and route of medication
or IV fluid
-
Date and time of order
-
Physician signature or stamp
2.
Assesses the patient for the following before Iv
cannula insertion
-
Current anti coagulant/thrombolytic therapy or
blood dyscrasiasis
-
Allergy history (eg. Lidocaine, EMLA cream,
antiseptic solution ,adhesives)
-
History of mastectomy , fistula, shunt,
neurovascular injury, cellulitis and thrombosis
-
Patient age, size , skin condition and anatomy
of venous system
3.
Assemble necessary equipment
-
IV catheter of appropriate type, size and length
-
IV fluid /medication as prescribed with IV
administration set and short extension tubing attached and primed
-
Tourniquet
-
Alcohol swab /povidine iodine pads
-
Square gauze –sterile
-
Transparent semi permeable dressing
-
Syringe with 3 to 5 ml of Normal saline
4.
Prepares
the patient for insertion of an intravenous cannula
-
Ensures that the patient and family understand
procedure teaching
-
Position the patient in a supine position with
the head slightly elevated and arms at side
-
Extend the patient upper extremity to form a
straight line from the shoulder to the wrist
5.
Washes hand
6.
Select appropriate venipuncture site and uses
the most distal branch of the veins selected.
7.
Applies tourniquet on extremity approximately
10cm above venipuncture site.
8.
Dons sterile gloves
9.
Cleanses the selected venipuncture site with
alcohol swab using circular motion from the center outwards.
10.
Draws the skin just below the insertion site taut, using the thumb of the non dominant
hand.
11.
Puncture the skin parallel to the path of the
vein with the bevel up and needle at 15 degree angle
12.
Advances the needle until blood is observed in
the catheter hub or tubing of winged infusion set. Holding the device stable
,advances the catheter into the vein until hub rests at insertion site
13.
Releases tourniquet
14.
Place 4x4 gauze pad under the catheter hub and
removes the stylet and disposes in to sharp box
15.
Connects primed IV administration or syringe
with normal saline to catheter hub
16.
Initiates proper iv flow rate or flushes with
3ml of normal saline . Assesses for sign of infiltration
17.
Secure the catheter with transparent semi
permeable dressing
18.
Labels dressing with date, time, catheter gauge
and initials
19.
Discard supplies in appropriate container and
washes hands
Document the procedure
1.
Documents the following on critical care flow
sheet/nurses note
-
Patient and family education
-
Known allergies
-
Date and time of procedure
-
Catheter type, Gauge and length
-
Type and amount of local anaesthesia (if used)
-
Location of peripheral IV insertion
-
Problem encountered during or after procedures
and nursing interventions
-
Patient tolerance of procedure
-
Assessment of insertion site
CHAPTER 7
OXYGEN
THERAPY
About oxygen therapy
1.
Indicates purposes of oxygen therapy
-
To treat Hypoxia
-
To decrease the respiratory effort
-
To decrease work load of the heart
2.
States indications of oxygen therapy
-
Chest pain
-
Decreased PaO2
-
Clinical sign of hypoxia (dyspnea, tachypnea,
paleness, cyanosis, restlessness and disorientation).
3.
Discusses conditions requiring special
precaution related to oxygen therapy
-
Individual with chronic obstructive pulmonary
diseases usually retains high level of CO2 and his respiratory drive is
impaired by high O2 concentration
-
Premature infant cannot tolerate prolonged
periods of high concentration of O2,because the possibility of retina artery
damaged which may lead to retrolental fibrosis and blindness
-
Premature infant cannot tolerated prolonged
periods of high concentration of O2,because the possibility of retina artery
damaged which may lead to retrolental fibrosis and blindness
Different ways of oxygen therapy and
applications
1.
Nasal cannula
-
It is to deliver low oxygen concentration and
allow the patient comfort in talking ,eating and coughing it is in low flow
oxygen device that directs oxygen through two plastic prongs that have been
inserted into nares
2.
Oxygen mask
a.
Simple face mask: it is a low flow system that
uses the nose, nasopharynx and oropharynx as an anatomic reservoir.
b.
Venturi mask it is mask which provides
controlled low to moderate oxygen concentration.
c.
The partial rebreathing mask it is simple face
mask with an attached reservoir bag, contains no valves and generally use on
ill patients. Requiring an O2 concentration of 40-60% part of the patient
previously exhaled air is rebreathed, missing PaCO2.
d.
Non rebreathing face mask: it is a simple mask
with a reservoir bag that includes a one way valve between the bag and the mask
and two one-way valves on the mask exhalation side ports. These valves prevent
the entry of room air through the exhalation ports, delivering 80-100% oxygen
and require a high flow (10-15lpm).
Documentation relevant data
Documentation
24 hr flow sheet should include
-
Respiratory assessment before and after the
application of O2
-
Type of O2 delivery used
-
Patient response to O2 administration
-
Documentation of any complaint or discomfort or
dry mouth throat or thickening of secretion.
-
Document nursing care given
Patient family education
1.
Discusses and demonstrate the steps and modes of
O2 delivery
2.
Explain the sign and symptoms of respiratory
failure to patient and family
3.
Explains the possible complication and their
preventive measures
4.
Explains the importance of O2 use
CHAPTER 8
SAMPLING
FOR INVESTIGATION
DEFINITION :
The amount of blood withdrawn
from the peripheral vein and kept it in special tube to send to Laboratory for
diagnostic purposes.
PURPOSE :
To withdrawn blood for diagnostic purposes
POLICY :
1.
Peripheral vein blood collection may be
performed by a qualified, trained staff nurse, with a written order of a
Physician.
2. Proper hand washing and gloving should be
observed
3. Once collected, all samples must be
transferred in proper laboratory receptacle labeled
with patient's name and
medical record number and sent to laboratory accompanied
by appropriate laboratory request.
4. The amount of blood withdrawn must be
recorded in the I & O sheet for the purpose of monitoring blood volume
depletion.
MATERIAL & EQUIPMENT :
1. Tourniquet
2. Gloves
3. Syringe or evacuated tubes
4. 70 % alcohol or antiseptic solution
5. 21 – 25 gauge needle or scalp vein needle
6. Blood collection tubes or tubes needed
for specimen investigation
7. Labels
8. Laboratory request form
9. 2 x 2 gauze pads
10. Adhesive bandage
PROCEDURE :
1. Wash hands
thoroughly and don gloves
2. Explain
the procedure to the patient and the parents for small child / baby
3. Position
the patient and assess the patient's
vein
4. Tie a
tourniquet proximal to the area chosen for venipuncture
5. Clean the
venipuncture site with alcohol sponge
Don't wipe off
the antiseptic solution with alcohol Wipe in a circular motion, spiraling outward from the site
6. Position
the syringe, insert the needle into the vein, withdraw the blood slowly,
pulling the plunger of the syringe
gently.
7. Remove the
tourniquet as soon as blood flows adequately
8. After sample has been extracted, remove the
needle from the vein gently then apply gentle pressure to the puncture site
until bleeding stops and apply adhesive bandage.
9. Assess
venipuncture site for oozing, bleeding or evidence of hematoma.
10. Record the date and time of blood sample
collection, the name of the test the amount of blood collected and any adverse
reaction to the procedure.
CHAPTER 9
INSERTION
OF NASOGASTRIC TUBE
DEFINITION:
Nasogastric tube insertion is the introduction of a rubber
or plastic tube (with
radiopaque marker or strip at the
distal end) into the stomach via the nose.
OBJECTIVE:
1. To remove fluid and gas present in or
regurgitated into
the
stomach.
2. To decompress the stomach thus
preventing gastric distention, nausea and vomiting.
3. To administer tube feeding and
medication to patient unable to eat by mouth or swallow a sufficient diet.
4. To collect gastric contents for
laboratory analysis.
5. To perform gastric lavage in case of
poisoning or overdose of drugs.
CONTRA-INDICATION:
The tube should not inserted nasally in the following cases:
1. Head trauma with suspicious fracture
base.
2. coagulapathy.
POLICY:
1. Standard precaution must be followed
in the performance of procedure
2. The physician will order, choose the
type and diameter of nasogastric tube that bests suits the patient’s needs.
3. Nasogastric tube shall be inserted by
the physician or upon order of the physician, by a qualified nurse with
adequate knowledge and skill on the procedure.
4. Insertion of nasogastric tube requires
close observation of the patient and verification of proper tube placement:
4.1 Aspiration of stomach content.
4.2 Inject ion of air into the catheter
while simultaneously listening with stethoscope the typical gurgling or
growling sound over hypogastrium.
4.3 X-ray
MATERIALS
& EQUIPMENT
1.
Nasogastric tubes of different size.
2. Solution basin filled with
warm water (for plastic tube) or ice (for rubber tube).
3. Emesis basin.
4. Penlight.
5. Non-allergenic adhesive
tape.
6. Gloves.
7. Water soluble lubricant.
8. Stethoscope.
9. Tongue blade.
10. Syringe as irrigation set.
11. Suction equipment if required.
12. Towel or line-saver pad.
13. Facial tissue.
14. Gauze swabs.
PROCEDURE:
1.
Wash
hands.
2.
Explain
the procedure to the patient. Inform that he/she may experience some nasal
discomfort, that he/she may gag, and that his/her eyes may water. Emphasize
that swallowing will ease the tube’s advancement. Agree on a signal that the
patient can use if he/she wants you to stop briefly during the procedure.
3.
Revise
all necessary equipment. If rubber tube is used, place it on ice. If a plastic
tube is being used, place it in warm water.
4.
Position
the patient into high Fowler’s unless contraindicated and support the head with
a pillow.
5.
Drape
the towel or linen-saver pad over the patient’s chest. Place the facial tissues
and emesis basin well within the patient’s reach.
6.
Help
the patient face forward with her neck in a neutral position. Determine how far
to insert the tube. Measure from the tip of the nose to the tip of the earlobe
to the end of xyphoid process. Mark this distance on the tubing with the tape.
7.
Use
the penlight and inspect for a deviated septum or other abnormalities. Ask the
patient if he/she had any nasal surgery or injury. Assess airflow in both
nostrils by occluding one after the other. Choose the nostril with better
airflow.
8.
Don
gloves.
9.
Lubricate
the first 3” of the tube well with water- soluble lubricant.
10.
Instruct
the patient to hold her head straight and upright. Insert the tube downward
into the selected nostril and advance it slowly with its natural curve toward
the nasopharynx.
11.
When
the tube reaches the nasopharynx, resistance is met. Instruct the patient to
lower his/her head slightly then, rotate the tube 180 degrees towards the
opposite nostril.
12.
Ask
the patient to swallow.
13.
If
there is no swallowing, insert the catheter smoothly and quickly.
14.
While
the tube is being inserted, watch for respiratory distress.
15.
Use a
tongue blade and penlight to examine the patient mouth and throat for signs of
coiled section of tubing.
16.
Once
catheter has been inserted to the premeasured length, ascertain correct tube
placement by:
16.1
Aspirate
small amount of stomach content. If no stomach content is obtained, position the patient on the side,
and aspirate again.
16.2
Inject
air into the catheter while simultaneously listening with stethoscope the typical
gurgling or growling sound over the hypogastrium.
16.3
Do
x-ray If these tests don’t confirm tube placement.
17. Secure the tube by taping to it to the
bridge of the patient's nose and bring split ends under the tubing and back up
over the nose.
18. Record the insertion procedure, type,
size and length of the NGT, and document type and amount of suction, if used,
drainage, including the amount, color, character, consistency, and odor, and
the patient's response to the procedure.
FOLLOW UP:
1. When confirming tube placement, never
place the tube’s end in a container of water.
2. Nasogastric tube must be changed every
seven days unless ordered otherwise by a physician.
3. The date of change must be recorded.
4. Manifestations of respiratory distress
must be assessed as the NGT is inserted. The tube must be removed immediate if
any sign is noted.
