Evidence Base for a Nursing Care of Nasogastric Tubes
Introduction
The care of older adults poses special challenges because of great variation in their physiological, cognitive, and psychosocial health. Older adults also vary widely in their levels of functional ability. Addressing the health concerns of the elderly specific for their age should be a health care priority. For this paper, caring for the elderly would be the focus of discussion. Given the developmental differences and changes, the elderly patients would somehow require a different approach in medication administration.
This paper focuses on developing the best practice guidelines for a patient with nasogastric tubes. Using various literatures, a plan for a patient is developed. Basically, this involves five phases, which are outlined in the concept map in the previous page. Artificial airways need to be maintained in the correct position to prevent airway damage. To illustrate, nasogastric tubes, if not properly administered and handled can create complications for the patient such as infections. The passage of food and air in the nasogastric tube is a difficult process which also requires expertise and care. There are certain guidelines that should be followed during suctioning and these are outlined below. However, even if there are recommended guidelines, sometimes these guidelines fall short of what should be expected or completely does not work at all for a certain situation. Thus, the nurse still has to apply critical thinking skills at all times when performing patient care.
Discussion
The presence of an artificial airway places a patient at high risk for infection and airway injury. Sterile technique is used in caring for and maintaining an artificial airway to prevent nosocomial infections. Artificial airways need to be maintained in the correct position to prevent airway damage.
Nasogastric tubes are used as short-term artificial airways to administer mechanical ventilation, relieve upper airway obstruction, protect against aspiration, or clear secretions. Nasogastric tubes are generally removed within 14 days; however, they may be used for a longer period of time if the patient is showing progress toward weaning from mechanical ventilation and extubation. The care of a patient with an nasogastric tube has five steps (2004).
A patient with an artificial airway is at an increased risk due to an inability or difficulty controlling secretions and due to pressure points of the artificial airway thus the rationale for observing signs and symptoms of need to perform care of the artificial airway. This could include soiled or loose tape, pressure sores, unstable tube, and excessive secretions (2004).
Identifying factors that increase risk of complication from nasogastric tubes includes the checking the type and size of the tube, movement of tube up and down the trachea, cuff size, and durations of placement. A tube moving up and down the nasal and gastric cavities disposes the patient to nasal trauma or dislodgement. Cuff underinflation may allow aspiration, whereas overinflation may cause ischemia or necrosis of nasal and gastric tissue. Loner duration increases risk of lower airway complications such as pneumonia (2004). The next step is to suction the nasogastric tube. Suctioning of gastric secretions may prevent postoperative atelectasis and, if properly carried out, may avoid the necessity for further nasal treatment.
In my own opinion, the most important provided in the literature review is this: Suctioning exhausts the patient and can cause cardiac arrest. Therefore, the duration of the total suctioning period should be brief so as not to exhaust the patient. Suctioning must be done with a fresh sterile catheter and tube to prevent contamination or infection (2006). Risks for infections and other complications are always a possibility for any patient. Thus, the nurse has to be utterly careful when performing suctioning. Additionally, a patient should not be thoroughly exhausted after the procedure because the patient may not be able to do that which is required of him to ensure continuity of care.
The concept map is a very simple one which contains the five basic steps in the care of an nasogastric tube patient, including suctioning. There are five branches of the concept map corresponding to the five basic steps. There are no more tertiary branches. The sub-steps for each of the basic step are then outlined in the literature review. The rationales for each step are also discussed in the literature review.
The design of the concept map used for this paper is very simple. There are two reasons for this choice. First is that this type of concept map is easier to create and modify. This saves time on making the concept map and delegates more time to the search for the best practice guidelines. The second reason is that a concept map on nasogastric tube suctioning does not require a complex one but a simple one to be able to fully illustrate the steps. Further information on each step is contained in the literature review instead. Overall, the concept map serves its purpose. It is simple and easy to understand.
Conclusion
Thus, a nurse’s critical thinking skills are also very useful when faced with a situation that cannot be acted upon with recommended guidelines. Others who will read this will able to get the basic idea of how to provide nasogastric tube suctioning and care. If at some point, the recommended guidelines do not work, then the nurse has to rely on her critical thinking skills to solve upon a problem. The references that have been quite helpful for this endeavor are listed below. All of them are important and have contributed to attaining the goal for this paper.
Furthermore, The health care professional must work collaboratively with the older adult to ensure safe and appropriate use of all medications that the elderly needs. This includes both prescribed and over-the-counter medications. The older adult should be taught the names of all drugs being taken, when and how to take them, and the desirable and undesirable effects of the drugs. If for some reason the elderly cannot understand, then it is better that another family member or a caregiver must be taught. The health care professional must also teach the elderly patient how to avoid adverse effects or interactions of drugs and how to establish and follow an appropriate self-administration pattern.
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