💓 Savvy NurseLouvri aplikasyon an

🛏️ Swen Debaz ak Konfò · Leson 2 sou 6 · 7 min

Tib NG, Nitrisyon Enteral ak Kijan pou Manje Pa Ale nan Poumon

NG Tubes, Enteral Feeds and Keeping Food Out of Lungs

🫗 Ponp nitrisyon an ap mache. Pasyan an kouche plat paske 'fanmi an te vle li konfòtab'. Enfimyè a tande gargouyiman. Chak règ pou nitrisyon pa tib egziste akoz sèn sa a.

🫗 The feeding pump is running. The client is lying flat because 'the family wanted him comfortable'. The nurse hears gurgling. Every rule for tube feeding exists because of this scene.

💡 Ide prensipal

Reyon X konfime plasman; pH 5 oswa pi ba sipòte li. Tèt kabann 30 a 45 degre, rense 30 mL alantou medikaman yo, yon medikaman alafwa, pa janm kraze liberasyon pwolonje.

X-ray confirms placement; pH 5 or lower supports it. Head of bed 30 to 45 degrees, flush 30 mL around meds, one drug at a time, never crush extended-release.

🧠 Poukisa sa enpòtan

Konfime plasman tib NAZOGASTRIK la ak REYON X anvan premye itilizasyon an; sa se estanda lò a. Bò kabann lan, verifye pH gastrik la (5 oswa pi ba sijere lestomak) epi make tib la nan narin yo; oskilte lè ou enjekte a pa fyab epi ou pa dwe itilize li pou verifye plasman. Pou PREKOSYON ASPIRASYON, kenbe tèt kabann lan a 30 a 45 degre pandan nitrisyon an epi pou 30 a 60 minit apre, verifye rezidi gastrik selon pwotokòl epi kenbe oswa rapòte gwo volim ak distansyon, noze oswa vomisman, epi rense ak 30 mL dlo anvan ak apre medikaman ak nitrisyon. Bay medikaman yo youn pa youn, rense ak omwen 15 mL dlo ant chak youn. Kraze sèlman konprime liberasyon imedyat ki apwouve pou kraze, pa janm kraze pwodwi kouvèti enterik, liberasyon pwolonje, siblengwal oswa bikal, epi verifye ak famasyen an anvan ou kraze medikaman danjere. Pou disfaji apre yon estwok, kenbe pasyan an dwat, itilize vale ak manton pliye, ofri likid epè jan yo preskri li a, evite likid fen ak pay, epi kenbe aspirasyon disponib. Touse pandan repa, yon vwa mouye oswa ki gargouye, ak manje ki rete nan bouch se siy avètisman; rete epi rapòte.

Confirm NASOGASTRIC tube placement by X-RAY before the first use; this is the gold standard. At the bedside, check gastric pH (5 or lower suggests the stomach) and mark the tube at the nares; auscultating injected air is unreliable and should not be used to check placement. For ASPIRATION PRECAUTIONS, keep the head of the bed at 30 to 45 degrees during feeding and for 30 to 60 minutes after, check gastric residual per policy and hold or report high volumes with distention, nausea or vomiting, and flush with 30 mL of water before and after medications and feedings. Give medications one at a time, flushing with at least 15 mL of water between each one. Crush only immediate-release tablets approved for crushing, never crush enteric-coated, extended-release, sublingual or buccal products, and check with the pharmacist before crushing hazardous drugs. For dysphagia after a stroke, keep the client upright, use a chin-tuck swallow, offer thickened liquids as ordered, avoid thin liquids and straws, and keep suction available. Coughing with meals, a wet or gurgling voice, and pocketing food are warning signs; stop and report.

🏥 Nan lavi reyèl

💊 Yon enfimyè kraze metoprolol liberasyon pwolonje yon pasyan nan yon tib nitrisyon pou li ekonomize tan. Tout dòz 24 èdtan an frape anmenmtan; pasyan an vin bradikadik ak ipotansif. Famasyen an konvèti lòd la an yon fòm liberasyon imedyat yo bay an dòz divize. 'XL', 'ER', 'SR' ak 'EC' sou yon etikèt se fason egzamen an di 'pa kraze'.

💊 A nurse crushes a client's extended-release metoprolol into a feeding tube to save time. The whole 24-hour dose hits at once; the client becomes bradycardic and hypotensive. The pharmacist converts the order to an immediate-release form given in divided doses. 'XL', 'ER', 'SR' and 'EC' on a label are the exam's way of saying 'do not crush'.

📌 Sa pou retni

  • Reyon X anvan premye itilizasyon; pH ≤ 5 ak mak nan narin bò kabann lanX-ray before first use; pH ≤ 5 and nares marking at the bedside
  • Tèt kabann 30 a 45 degre pandan ak apre nitrisyon; rense 30 mL anvan ak apre medikaman yoHOB 30 to 45 degrees during and after feeds; flush 30 mL before and after meds
  • Pa janm kraze medikaman kouvèti enterik oswa liberasyon pwolonjeNever crush enteric-coated or extended-release medications

✅ Teste tèt ou

Ki metòd ki pi fyab pou konfime plasman inisyal yon tib nazogastrik yo fèk mete?Which method is the most reliable for confirming initial placement of a newly inserted nasogastric tube?
  1. Reyon X nan vantAbdominal X-ray
  2. Enjekte lè epi oskilte sou lestomak laInjecting air and auscultating over the stomach
  3. Verifye pH aspirasyon anChecking the pH of aspirate
  4. Obsève pasyan an k ap valeObserving the client swallow

Repons: A · Reyon X nan vant

Konfimasyon radyografik se estanda lò a anvan premye itilizasyon an. Verifikasyon pH se yon sipleman bò kabann pou kontwòl kontini.

Radiographic confirmation is the gold standard before the first use. pH checking is a bedside supplement for ongoing checks.

Yo dwe repozisyone yon pasyan k ap resevwa nitrisyon kontini pa tib. Ki pozisyon tèt kabann ki kòrèk pandan ak apre nitrisyon an?A client receiving continuous tube feeding must be repositioned. What is the correct head-of-bed position during and after the feeding?
  1. Elve 10 a 15 degreElevated 10 to 15 degrees
  2. PlatFlat
  3. Trendelenburg
  4. Elve 30 a 45 degreElevated 30 to 45 degrees

Repons: D · Elve 30 a 45 degre

Elve tèt kabann lan diminye refliks ak aspirasyon pandan ak apre nitrisyon enteral. Elve 10 a 15 degre twò ba pou anpeche refliks; tèt kabann lan bezwen omwen 30 degre.

Elevating the head of the bed reduces reflux and aspiration during and after enteral feeding. Elevated 10 to 15 degrees is too low to prevent reflux; the head of the bed needs at least 30 degrees.

Yon pasyan ki gen disfaji apre yon estwok touse epi li gen yon vwa ki gargouye pandan li ap bwè dlo. Kisa enfimyè a dwe fè?A client with dysphagia after a stroke coughs and has a gurgling voice while drinking water. What should the nurse do?
  1. Ofri likid fen sèlmanOffer thin liquids only
  2. Ankouraje pasyan an bwè pi vit ak yon payEncourage the client to drink faster through a straw
  3. Rete konsomasyon oral epi mande yon evalyasyon valeStop oral intake and request a swallow evaluation
  4. Kouche pasyan an plat pou li repozeLie the client flat to rest

Repons: C · Rete konsomasyon oral epi mande yon evalyasyon vale

Touse ak yon vwa mouye endike aspirasyon. Rete, pwoteje vwa respiratwa a epi jwenn yon evalyasyon patoloji lapawòl-langaj. Ofri likid fen sèlman fè aspirasyon pi posib, paske likid fen deplase pi vit epi se konsistans ki pi difisil pou kontwole.

Coughing and a wet voice indicate aspiration. Stop, protect the airway and obtain a speech-language pathology evaluation. Offering thin liquids only makes aspiration more likely, because thin liquids move fastest and are the hardest consistency to control.

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