Gastrointestinal System Disorders Q 294

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A nurse is inserting a nasogastric tube in an adult male client. During the procedure, the client begins to cough and has difficulty breathing. Which of the following is the appropriate nursing action?

  

    A. Quickly insert the tube

    B. Notify the physician immediately

    C. Remove the tube and reinsert when the respiratory distress subsides

    D. Pull back on the tube and wait until the respiratory distress subsides

    

    

Correct Answer: D. Pull back on the tube and wait until the respiratory distress subsides

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During the insertion of a nasogastric tube, if the client experiences difficulty breathing or any respiratory distress, withdraw the tube slightly, stop the tubing advancement, and wait until the distress subsides. The most common indication for placement of a nasogastric tube is to decompress the stomach in the setting of distal obstruction. Less commonly, nasogastric tubes can be placed to administer medications or nutrition in patients who have a functional gastrointestinal tract but are unable to tolerate oral intake.

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Option A: Quickly inserting the tube is not an appropriate action because, in this situation, it may be likely that the tube has entered the bronchus. A common error when placing the tube is to direct the tube in an upward direction as it enters the nares; this will cause the tube to push against the top of the sinus cavity and cause increased discomfort.

Option B: Notifying the physician immediately is unnecessary. If there is a great deal of difficulty in passing the tube, a helpful maneuver is to withdraw the tube and attempt again after a short break in the contralateral nares as the tube may have become coiled in the oropharynx or nasal sinus.

Option C: Removing the tube is unnecessary. The tip should instead be directed parallel to the floor, directly toward the back of the patient’s throat. At this time, the patient can be given a cup of water with a straw in it to sip from to help ease the passage of the tube. The tube should be advanced with firm, constant pressure while the patient is sipping.

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