Gastrointestinal intubation.pptx

1. GASTROINTESTINAL INTUBATION
PRESENTED BY :
V.RAMYA,
TUTOR.

2. DEFINITION
It is the insertion of flexible tube into the stomach
or beyond the pylorus into the duodenum (the first
section of the small intestine )or the jejunum ( the
second section of the small intestine)
The tube may be inserted through the mouth,the
nose, or the abdominal wall.

3. PURPOSE
 Decompress the stomach
 Lavage the stomach
 Diagnose GI disorders
 Administer medications and tube feedings and fluids
 Treat an obstruction
 Compress a bleeding site
 Aspirate GI contents for analysis

4. TYPES OF TUBES
Gastric tubes
Levin
Sump
Enteric tubes

5. NASOGASTRIC TUBE

6. LEVIN TUBE

7. GATRIC SUMP TUBE

8. ENTERIC TUBE

9. Nursing Care of the Patient with a Nasogastric or
Naso enteric Tube
 Patient teaching and preparation
 Tube insertion
 Confirming placement
 Securing the tube
 Monitoring the patient
 Maintaining tube function
 Oral and nasal care
 Monitoring, preventing, and managing complications
 Tube removal

10. Measuring for Nasogastric Tube Insertion

11. Securing the NG Tube

12. Purposes and Advantages of Enteral Feeding
 Meets nutritional requirements when oral intake is in adequate or
not possible, and the GI tract is functioning
 Advantages:–
 Safe and cost-effective
 Preserves GI integrity
 Preserves the normal sequence of intestinal and hepatic metabolism
 Maintains fat metabolism and lipoprotein synthesis
 Maintains normal insulin and glucagon ratios

13. Tube Feeding Administration Methods
 Tubes
 Nasogastric or nasoenteral tubes
 Gastrostomy or jejunostomy tubes for long-term feeding
 Methods
 Intermittent bolus feedings
 Intermittent gravity drip
 Continuous infusion
 Cyclic feeding

14. Bolus Gastrostomy Feeding by Gravity

15. Nasoenteric Feeding by ContinuousControlled
Pump

16. Nursing Process: The Care of the Patient Receiving
an Enteral Feeding: Assessment•
 Nutritional status and nutritional assessment
 Factors or illnesses that increase metabolic needs
 Hydration and fluid needs
 Digestive tract function
 Renal function and electrolyte status
 Medications that affect nutrition intake and function of the GI tract
 Compare the dietary prescription to the patient’s needs.

17. Nursing Process: The Care of the Patient Receiving
an Enteral Feeding: Diagnosis
 Imbalanced nutrition
 Risk for diarrhea
 Risk for ineffective airway clearance
 Risk for deficient fluid
 Risk for ineffective coping
 Risk for ineffective therapeutic regimen management
 Deficient knowledge

18. Collaborative Problems/Potential Complications
 Diarrhea
 Nausea and vomiting
 Gas/bloating/cramping
 Dumping syndrome
 Aspiration pneumonia
 Tube displacement
 Tube obstruction
 Nasopharyngeal irritation
 Hyperglycemia
 Dehydration and azotemia

19. Nursing Process: The Care of the Patient Receiving
an Enteral Feeding: Planning
 Major goals may include nutritional balance,
 Normal bowel elimination pattern,
 Reduced risk of aspiration,
 Adequate hydration,
 Individual coping,
 Knowledge of and skill in self-care,
 And prevention of complications.

20. Maintaining Nutrition Balance and Tube Function
 Administer feeding at prescribed rate and method and according to patient tolerance.
 Measure residual prior to intermittent feedings and every 4-8hours during continuous
feedings.
 Administer water before and after each medication and each feeding, before and after
checking residual, every 4 to 6 hours, and whenever the tube feeding is discontinued
or interrupted.
 Do not mix medications with feedings.
 Use a 30-mL or larger syringe.
 Maintain delivery system as required.
 To avoid bacterial contamination, do not hang more than 4 hours of feeding in an
open system.

21. Maintaining Normal Bowel Elimination
 Selection of Tube Feeding formula:
 consider fiber, osmolality, and fluid content
 Prevent contamination of Tube Feeding:
 maintain closed system, do not hang more than 4 hours of Tube
Feeding in an open system.
 Maintain proper nutritional intake.
 Assess for reason for diarrhea and obtain treatment as needed.
 Administer Tube Feeding slowly to prevent dumping syndrome
 Avoid cold Tube Feeding.

22. Reduce Risk for Aspiration
Elevate Head Of Bed at least 30-
45 degrees during and for atleast
1 hour after feedings.
•Monitor residual volumes.

23. Other Interventions
Maintain hydration by supplying additional
water and assessing for signs of dehydration.
Promote coping by support and
encouragement;
Encourage self-care and activities.
Patient teaching

24. Gastrostomy Tubes
Types of tubes:–
Stamm
Janeway
PEG
Low-profile gastrostomy device (LPGD)
Insertion of the PEG tube

25. STAMM TUBE

26. Gastrostomy (PEG) Tubes

27. Nursing Process: The Care of the Patient With a
Gastrostomy: Assessment
Patient knowledge and ability to learn
Self-care ability and support
Skin condition
Nutrition and fluid status

28. Nursing Process: The Care of the Patient With a
Gastrostomy: Diagnosis
Imbalanced nutrition
Risk of infection
Risk for impaired skin integrity
Ineffective coping
Disturbed body image
Risk for ineffective therapeutic regimen management

29. Collaborative Problems/Potential
Complications
Wound infection
GI bleeding
Premature removal of tube
Aspiration
Constipation
Diarrhea

30. Nursing Process: The Care of the Patient With a
Gastrostomy: Planning
Major goals include attaining an optimal level of nutrition,
Preventing infection,
 Maintaining skin integrity,
Enhancing coping skills,
Adjusting to changes in body image,
Acquiring knowledge of and skill in self-care,
And preventing complications.

31. Tube Care and Preventing Infection
Proper use of dressing
Skin care around the tube
Manipulation of the stabilizing disk
to prevent skin breakdown

32. PERCUTANEOUS ENDOSCOPIC
GASTROTOMY Dressing

33. Indications for Parenteral Nutrition
A method to provide nutrients to the body by an IV route
A complex mixture containing proteins, carbohydrates ,
fats, electrolytes, vitamins, trace minerals, and sterile
water is administered in a single container.
The goals of parenteral nutrition are to improve nutritional
status and to attain a positive nitrogen status.

34. Nursing Process: The Care of the Patient Receiving
Parenteral Nutrition : Assessment
 Assist in identifying patients who are candidates for Parenteral
Nutrition
 Nutrition status
 Hydration status
 Electrolytes
 Signs and symptoms of hypoglycaemia / hyperglycemia
 Monitor blood glucose levels.
 Assess for potential complications
 Including temperature every 4 hours or by protocol

35. Nursing Process: The Care of the Patient
Receiving Parenteral Nutrition: Diagnosis
 Imbalanced nutrition
 Risk for infection
 Risk for excess or deficient fluid
 Risk for immobility
 Risk of ineffective therapeutic regimen

36. Collaborative Problems and Potential
Complications
 Pneumothorax
 Clotted or displaced catheter
 Sepsis
 Hyperglycemia
 Rebound hypoglycaemia
 Fluid overload

37. Nursing Process: The Care of the Patient Receiving
Parenteral Nutrition: Planning
Major goals may include attaining an optimal level of
nutrition,
Absence of infection,
Adequate fluid volume,
Optimal level of activity,
Knowledge of self-care, and
Absence of complications.

38. Prevention of Infection
Appropriate catheter and IV site care
Strict sterile technique for dressing changes
Wear mask when changing the dressing.
Assess insertion site.
Assess for indicators of infection.
Proper IV and tubing care

39. Maintaining Fluid Balance
Use infusion pump.
Flow rate should not be increased or decreased rapidly.
If fluid runs out, hang 10% dextrose solution.
Monitor indicators of fluid balance and electrolyte levels.
I&O
Weights
Monitor blood glucose levels.

40. Patient Teaching
Goals and purpose
Components of Parenteral Nutrition
Emergency contact numbers
Demonstrate use of equipment and how to handle and
hang the IV.
Demonstrate dressing changes.
Demonstrate how to flush or heparinize the catheter.
Potential complications and actions to take

41. BIBLIOGRAPHY
 Brunner and Suddarth’s Textbook of Medical- Surgical Nursing ,South Asian
 Edition , Volume 1 , Published by Wolters Kluwer . Page reffered to 817-838.
 Ansari and Kaur, Textbook of Medical – Surgical Nursing 1 , Published by Pee
 Vee 2011 Edition, Page reffered to 810 – 822.
 https://www.slideshare.net/arifasudheer/nasogastric-intubation-151445458