A practical nurse (PN) is inserting a nasogastric (NG) tube for a client with a bowel obstruction. To reduce the risk of respiratory trauma and aspiration, arrange the following procedural steps in the correct chronological order.
- 1Measure the required tube length from the tip of the nose to the earlobe, then down to the xiphoid process.
- 2Ask the client to slightly hyperextend their neck backward while gently advancing the tube through the naris.
- 3Instruct the client to flex their head forward, bringing the chin toward the chest, once the tube reaches the oropharynx.
- 4Advance the tubing smoothly in coordination with the client actively swallowing sips of water.
- 5Aspirate a small amount of stomach contents and test the pH to assess initial placement.
Cevap
The correct sequence for safe nasogastric tube insertion is to first measure the required tube length, then hyperextend the client's neck for initial nasal insertion, flex the chin to the chest once the tube reaches the throat, advance the tube while the client swallows, and finally verify placement by aspirating and testing the pH.
The correct sequence ensures client safety by aligning the airway anatomy appropriately at each stage of the procedure. Measurement must occur first to identify the target depth. The head is tilted back initially only to facilitate nasal entry. Crucially, the head must be tilted forward (chin-to-chest) when the tube reaches the back of the throat to close the trachea. Swallowing assists esophageal passage, and verifying placement via pH is the final bedside safety check before utilizing the tube.
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Anahtar Kavram
Correct anatomical positioning—specifically transitioning from neck hyperextension to chin-to-chest flexion—during nasogastric tube insertion is a critical maneuver to close the airway and prevent accidental tracheal intubation.