Hello, this is a request from the Medical-Surgical Nursing Laboratory and the professor wants a nursing note related to the care of a nasogastric tube or PEG tube (no less than 10 sentences) Please create a real case in an unreal patient and You must complete the attached file with the patient’s nursing care notes with Nasogastric Tube or a PEG Tube. Bibliography: 1. Ignatavicius, D., & Workman, M. (2015). Medical-Surgical Nursing (8th ed.). St Louis, Missouri: Elsevier. ISBN: 9781455772551.

Clinical Scenario:

Patient Information:
Name: John Doe
Age: 45 years
Gender: Male
Medical History: Chronic pancreatitis

Nursing Note – Nasogastric Tube Care:

Date: 01/10/2023

Subjective data:
The patient, John Doe, complains of persistent abdominal pain, nausea, and vomiting. He reports feeling bloated and has not had a bowel movement in the past two days. The patient states that his symptoms have worsened over the last week.

Objective data:
– Vital signs: Temperature 37.2°C, Blood Pressure 130/80 mmHg, Pulse 90 bpm, Respirations 18 breaths per minute.
– Abdominal assessment reveals tenderness and distension with hypoactive bowel sounds.

Assessment:
Based on the subjective and objective data, it is suspected that the patient is experiencing a bowel obstruction. A nasogastric tube (NGT) will be inserted to decompress the stomach and relieve symptoms.

Plan:
1. Explain the procedure to the patient and obtain informed consent, ensuring the patient’s understanding and willingness to proceed.
2. Gather necessary supplies, including a nasogastric tube, water-soluble lubricant, gloves, adhesive tape, syringe, and cup of drinking water.
3. Perform hand hygiene and don personal protective equipment (PPE) including gloves and apron.
4. Verify patient identification using the two patient identifiers (e.g., name and date of birth).
5. Position the patient in a semi-Fowler’s position to facilitate insertion.
6. Measure the appropriate length of the NGT from the tip of the nose to the earlobe and then extending it to the xiphoid process.
7. Apply water-soluble lubricant to the tip of the NGT.
8. Gently insert the tube through the chosen nostril, advancing it towards the back of the throat.
9. Instruct the patient to tilt their head slightly forward and swallow as the tube is passed into the esophagus and down into the stomach.
10. Verify proper placement of the NGT by confirming the presence of stomach contents aspirated through the tube and confirming the length of the inserted tube matches the initial measurement.
11. Secure the NGT in place using adhesive tape, ensuring it is neither too tight nor too loose.
12. Position the patient comfortably ensuring that there are no kinks or loops in the tubing, which could impede the flow of stomach contents.
13. Document the procedure, including patient tolerance, any complications, and the length of the NGT inserted.

Rationale:
– Nasogastric intubation is necessary to decompress the stomach and relieve symptoms of bowel obstruction.
– Obtaining informed consent is essential to respect the patient’s autonomy and ensure they are aware of the procedure’s purpose and potential risks.
– Proper hand hygiene and PPE prevent healthcare-associated infections.
– Verifying patient identification reduces the risk of performing the procedure on the wrong patient.
– Positioning the patient in a semi-Fowler’s position facilitates tube insertion and minimizes the risk of aspiration.
– Measuring the length of the NGT ensures appropriate placement and prevents complications such as bronchial intubation.
– Lubricating the tube facilitates smooth insertion and reduces discomfort for the patient.
– Instructing the patient to swallow helps to guide the tube into the esophagus and reduces the risk of misplacement.
– Confirming proper placement by aspirating stomach contents and comparing the tube length helps prevent complications associated with misplacement.
– Securing the NGT prevents accidental displacement and maintains proper functioning.
– Ensuring the tubing is not kinked or looped allows for uninterrupted drainage and prevents complications such as blockage or reflux.
– Documenting the procedure provides an accurate record and ensures continuity of care.

In conclusion, this nursing note outlines the care provided for the insertion and management of a nasogastric tube in a patient with suspected bowel obstruction. By following the appropriate steps and considering the rationale behind each action, optimal care can be provided, ensuring patient comfort and safety.