🛏️ 基础护理与舒适 · 第2课，共6课 · 7 min

NG管、肠内喂养与防止食物进入肺部

NG Tubes, Enteral Feeds and Keeping Food Out of Lungs

🫗 喂养泵正在运行。患者平躺着，因为家属希望他舒服一些。护士听到了咕噜声。管饲的每一条规则都是因为这样的场景而存在的。

🫗 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.

💡 核心要点

X-ray确认位置；pH为5或更低可支持这一判断。床头保持30到45度，给药前后用30 mL冲管，逐一给予药物，绝不能压碎缓释药物。

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.

🧠 为什么重要

首次使用前要通过X-RAY确认鼻胃管的位置；这是金标准。在床旁要检查胃液pH（5或更低提示位于胃内）并在鼻孔处标记管路；听诊注入空气的方法不可靠，不应用来检查位置。对于误吸预防，要将床头保持在30到45度，在喂养期间以及喂养后30到60分钟内均保持这一高度，按规定检查胃残余量，并在出现腹胀、恶心或呕吐且量大时暂停或报告，还要在给药和喂养前后用30 mL水冲管。要逐一给予药物，每种药物之间至少用15 mL水冲管。只能压碎经批准可压碎的速释片，绝不能压碎肠溶、缓释、舌下或颊部制剂，并在压碎危险药物前向药剂师确认。对于卒中后吞咽困难，要让患者保持直立、使用收下巴吞咽法、按医嘱提供增稠液体、避免稀液体和吸管，并保持吸引设备可用。进餐时咳嗽、声音湿润或带咕噜声，以及食物滞留在口腔内都是警示征象；要停止并报告。

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.

🏥 真实场景

💊 一名护士为了省时间，把患者的缓释metoprolol压碎后放入喂养管。整整24小时的剂量一下子全部进入体内；患者出现心动过缓和低血压。药剂师将医嘱改为分次给予的速释剂型。标签上的XL、ER、SR和EC就是考试在告诉你不要压碎。

💊 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'.

📌 要点总结

首次使用前做X-ray；床旁检查pH ≤ 5并在鼻孔处标记X-ray before first use; pH ≤ 5 and nares marking at the bedside
HOB在喂养期间和之后保持30到45度；给药前后用30 mL冲管HOB 30 to 45 degrees during and after feeds; flush 30 mL before and after meds
绝不能压碎肠溶或缓释药物Never crush enteric-coated or extended-release medications

✅ 自我测试

确认新插入鼻胃管初始位置最可靠的方法是哪一种？Which method is the most reliable for confirming initial placement of a newly inserted nasogastric tube?

腹部X-rayAbdominal X-ray
注入空气并在胃部上方听诊Injecting air and auscultating over the stomach
检查抽吸液的pHChecking the pH of aspirate
观察患者吞咽Observing the client swallow

答案: A · 腹部X-ray

影像学确认是首次使用前的金标准。pH检查是持续检查时的床旁补充方法。

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

一名接受持续管饲的患者需要变换体位。喂养期间和之后正确的床头位置是什么？A client receiving continuous tube feeding must be repositioned. What is the correct head-of-bed position during and after the feeding?

抬高10到15度Elevated 10 to 15 degrees
平放Flat
Trendelenburg体位Trendelenburg
抬高30到45度Elevated 30 to 45 degrees

答案: D · 抬高30到45度

抬高床头可减少肠内喂养期间和之后的反流和误吸。抬高10到15度太低，无法防止反流；床头至少需要30度。

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.

一名卒中后吞咽困难的患者喝水时咳嗽且声音带咕噜声。护士应该怎么做？A client with dysphagia after a stroke coughs and has a gurgling voice while drinking water. What should the nurse do?

只提供稀液体Offer thin liquids only
鼓励患者用吸管喝得更快Encourage the client to drink faster through a straw
停止经口摄入并申请吞咽评估Stop oral intake and request a swallow evaluation
让患者平躺休息Lie the client flat to rest

答案: C · 停止经口摄入并申请吞咽评估

咳嗽和声音湿润提示误吸。要停止摄入、保护气道，并进行言语-语言病理学评估。只提供稀液体会使误吸更可能发生，因为稀液体流动最快，是最难控制的稠度。

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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