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Question

Difficulty: MediumReduction of Risk Potential

A practical nurse is preparing to administer a scheduled crushed medication via a client's nasogastric (NG) tube. To reduce the risk of complications, arrange the following nursing actions in the correct clinical sequence.

  1. 1Elevate the head of the bed to at least 30 to 45 degrees.
  2. 2Verify correct tube placement by aspirating gastric contents and assessing pH.
  3. 3Flush the nasogastric tube with 15 to 30 mL of sterile water.
  4. 4Instill the diluted medication into the syringe barrel, allowing it to flow by gravity.
  5. 5Flush the nasogastric tube again with 15 to 30 mL of sterile water.

Answer

The correct sequence is: Elevate the head of the bed, verify tube placement, flush with sterile water, administer the medication, and flush again.
Administering medications via a nasogastric tube requires a strict sequence to prevent life-threatening complications such as aspiration pneumonia and to maintain tube integrity. The client must first be positioned safely (head elevated). Next, tube placement is verified to confirm gastric location. A pre-flush ensures patency and clears the line. The medication is then administered by gravity, followed immediately by a post-flush to deliver the full dose and prevent clogs.

Step-by-Step Solution

1
Elevate the head of the bed to at least 30 to 45 degrees.
The client is placed in a semi-Fowler's position.
This utilizes gravity to reduce the risk of gastroesophageal reflux and aspiration into the lungs.
2
Verify correct tube placement by aspirating gastric contents and assessing pH.
Gastric placement is confirmed.
It is critical to ensure the tube has not become dislodged into the respiratory tract before instilling any fluids.
3
Flush the nasogastric tube with 15 to 30 mL of sterile water.
The tube is cleared of contents and patency is established.
Flushing prevents physical incompatibilities between gastric contents and the medication, while ensuring the tube is not blocked.
4
Instill the diluted medication into the syringe barrel, allowing it to flow by gravity.
The medication is delivered into the stomach.
Gravity instillation reduces the risk of applying too much pressure, which could damage the tube or the gastrointestinal mucosa.
5
Flush the nasogastric tube again with 15 to 30 mL of sterile water.
The tube is cleared of all medication residue.
This final flush ensures the client receives the entire medication dose and prevents the tube from becoming occluded by dried medication.

Key Concept

Safe administration of enteral medications requires sequential risk reduction techniques: aspiration prevention, placement verification, and occlusion prevention.
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Topics

Reduction of Risk Potential

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