Nursing English Modul

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

•          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

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.