Question

The nurse is preparing to administer a feeding via a nasogastric tube. The nurse would perform which of the following before initiating the feeding? A. Assess for tube placement by aspirating stomach content B. Place the patient in a left-lying position C. Administer feeding with \(50 \% \mathrm{H}_2 \mathrm{O}\) concentration D. Ensure that the feeding solution has been warmed in a microwave for 2 minutes

Short answer

Answer: The correct procedure to follow before initiating a feeding via a nasogastric tube is to assess for tube placement by aspirating stomach content.

Step-by-step solution

Option A: Assess for tube placement by aspirating stomach content

Before initiating the feeding process, it is essential to ensure that the nasogastric tube is correctly placed in the patient's stomach. Aspirating stomach content and verifying its pH (it should be acidic, between 1 and 5.5) helps in confirming the proper placement of the tube. Therefore, this step is correct.

Option B: Place the patient in a left-lying position

Placing the patient in a left-lying position is not a necessary step before initiating a feeding via a nasogastric tube. The correct position would be to elevate the head of the bed at an angle between 30-45 degrees to prevent aspiration. Hence, this step is incorrect.

Option C: Administer feeding with 50% H2O concentration

Feeding solutions should have specific compositions based on the patient's nutritional needs and medical condition. Administering a feeding with a 50% water concentration without knowing the patient's specific requirements would not be appropriate. In addition, the concentration of water has no direct relation to the need for assessing the tube placement before administering the feeding. Therefore, this step is incorrect.

Option D: Ensure that the feeding solution has been warmed in a microwave for 2 minutes

Warming the feeding solution might be a good practice for patient comfort. However, using a microwave to heat a feeding solution is not recommended as it could lead to uneven heating and create hot spots that might cause injury to the patient. The appropriate method would be to use a water bath or let the solution reach room temperature. Moreover, it does not relate to tube placement, which is the essential step before administering the feeding. Thus, this step is incorrect. Conclusion: The correct answer is Option A - Assess for tube placement by aspirating stomach content.

Key concepts

Nasogastric Tube Feeding

Nasogastric tube feeding is an important procedure used to provide nutrition to patients who cannot consume food orally. The tube is inserted through the nose and into the stomach, allowing liquid nutrition to bypass the mouth and esophagus.
This method is usually temporary and is used in various medical situations, such as patients with swallowing difficulties, severe anorexia, or those who are recovering from surgery and need nutritional support. Before starting the feeding process, it is crucial to confirm that the tube is placed correctly within the patient's stomach. This involves aspirating stomach content and checking the pH. The stomach's acidic environment should reflect a pH between 1 and 5.5.

• Proper tube placement reduces the risk of complications, such as feeding entering the lungs, which can lead to aspiration pneumonia.
• The feeding solution should meet the nutritional needs of the patient and be administered at room temperature to ensure comfort and safety.
• Close monitoring of the patient and the feeding process is crucial to quickly identify and address any issues that may arise.

Patient Safety in Nursing

Patient safety is a fundamental principle in nursing that focuses on preventing errors and harm to patients during healthcare delivery. In the context of nasogastric tube feeding, several safety measures should be implemented. One critical aspect is positioning the patient correctly. Patients should be positioned with their head elevated between 30-45 degrees during feeding. This position helps prevent aspiration, which is when the feeding solution accidentally enters the respiratory tract.

• Regular monitoring of the patient’s position during feeding is essential to maintain safety.
• Ensuring the feeding solution is of the correct composition and temperature helps prevent discomfort or injury; solutions should not be heated in a microwave due to the risk of uneven temperatures.
• Clear communication with other healthcare providers and documentation of feeding schedules and any occurrences during feeding further support patient safety.

Nursing Procedures

Nursing procedures, like nasogastric tube feeding, require a methodical approach to ensure they are performed safely and effectively. Before initiating the procedure, nurses must gather all necessary supplies and verify the identity of the patient to prevent any mix-ups. Preparation involves checking the liquid nutrition for correct ingredients based on medical orders and any specific needs of the patient. Performing a pre-feeding check on the tube’s position is vital to prevent any feeding mishaps. Aspiration of stomach contents and checking for acidic pH is a common practice to confirm correct placement.

• Nurses should routinely inspect the tube and skin around the insertion site for any signs of infection or irritation.
• Documentation of all steps taken during the procedure, the time of feeding, and any patient reactions ensures a comprehensive record for ongoing care.
• Continuous education on best practices and protocol updates are important for nurses to remain competent in performing nasogastric tube feeding safely.