Nursing Assignment: Potential Medical Problem and Rationale for Nasogastric Tube Insertion

This nursing assignment discusses the potential medical problem of acute colonic pseudo-obstruction and the rationale for nasogastric tube insertion. It also covers best practice techniques for both nasogastric tube insertion and indwelling catheter insertion, as well as nursing advocacy and current medications rationales.

Running head: NURSING ASSIGNMENT 1
Case Scenario
(Author’s name)
(Institutional Affiliation)

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Potential Medical Problem and Rationale for Nasogastric Tube Insertion
The potentials medical condition that Mrs. O’Reilly’s may be developing is acute colonic
pseudo-obstruction(Niu, Liang, & Zhang, 2017). Acute colonic pseudo-obstruction is one of the
large bowel obstruction disorders that do not necessarily involve mechanical obstruction but it is
characterized by abdominal distension(Niu et al., 2017). This medical condition is fatal as it can
lead to complications such as perforation and abdominal ischemia if not treated. It usually
presents to elderly patients and mostly after the abdominal surgical operation as they are at a risk
of constipation(Keller & Layer, 2015). Evidence shows that patients who have undergone total
hip replacement are at risk of developing pseudo-obstruction due to various reasons. These
include elderly and use of opioids analgesics(Keller & Layer, 2015). Mrs. O’Reilly has been
prescribed with Oxycodone for pain relief after undergoing elective hip replacement surgery.
Oxycodone is an opioid analgesic and given that she is receiving 5 to 10 mg six hourly can
contribute to acute colonic pseudo-obstruction(Kopecky, Fleming, Levy-Cooperman, O’Connor,
& M. Sellers, 2017). In addition, she is 70 years old of which elderly is another contributing
factor to the development of the condition.
A nasogastric tube is medical equipment normally prescribed to patients who cannot feed
orally due to unconsciousness, and other medical complication(Weijs et al., 2017). However, the
nasogastric tube can also be prescribed to patients who are postoperative as they are always on
nil by mouth. In addition, the nasogastric tube can be prescribed to patients with either large
bowel or small bowel obstruction for decompression purposes, that is, for suctioning of
abdominal content(Ricciuto, Baird, & Sant’Anna, 2015). However, evidence shows that, a
patient who has no emesis and has intestinal obstruction does not necessarily need the
nasogastric tube insertion. Mrs. O’Reilly has been indicated with Nasogastric tube as a method

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of relieving decompressions in the bowels. Given that she has bowel incontinence due to colonic
pseudo-obstruction, she cannot pass stool normally and the nasogastric tube will help in
removing abdominal contents(Yates, 2017). Other than that, she is experiencing emesis with a
stool odor which is a normal symptom of abdominal obstruction. Patient with emesis cannot
take drugs orally and therefore the nasogastric tube is indicated to enhance oral medication
intake given that she is receiving oral analgesics for pain management(Yates, 2017).
Best Practice Techniques in Nasogastric Tube Insertion
Before inserting a nasogastric tube to Mrs. O’Reilly, review the care plan and confirm
why it is indicated. For this case scenario, the nasogastric tube is indicated for suctioning of
abdominal content before further review(O’Sullivan, Blackburn, & Wakai, 2014). Explain to
Mrs. O’Reilly the purpose and the reason of inserting a nasogastric tube in order to gain the
consent. After that, prepare the environment and all the necessary equipment for the procedure.
This is done through the use of aseptic techniques and ensuring hand hygiene(O’Sullivan et al.,
2014). Prepare Mrs. O’Reilly by positioning her in a semi-fowler or sitting position where
possible with head supported and slightly flexed and put a protective towel into place(Ahmad,
Abdul-Hamid, & Abdul-Hamid, 2015). Since Mrs. O’Reilly is vomiting and has abdominal
obstructions, ensure that suction machine is available. Use the 14-16 gauge nasogastric tube and
lubricate the end with sterile water or normal saline. Measure the length of the tube and help the
patient to swallow by giving a small amount of water by a straw. Swallowing helps in tube
insertion as it helps to prevent gagging and vomiting and allows tube smoothly go through the
esophagus(Ahmad et al., 2015). Topical vasoconstrictor phenylephrine may help to shrink the
nasal mucosa when the passage is obstructed. While inserting, be aware of the complications of
the nasogastric insertions like tube coiling in the mouth, cyanosis, excess pain, and more

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coughing and sudden onset of abdominal pain. In addition, it is important to understand that a
nasogastric tube may go to the trachea and finally to the lungs other than the intended region
which is the gastric region(Ahmad et al., 2015). Due to that reason, one should be checking if
Mrs. O’Reilly has started showing some respiratory symptoms like coughing or difficulty in
breathing.
Evidence shows that there are risks involved during nasogastric tube insertion. One of
them is that the nasogastric tube might be inserted into the trachea which may lead to
complications. Due to that reason, nurses often apply the best practice to prevent such incidents
and promote patient safety(Weijs et al., 2017). For the case of Mrs. O’ Reilly, the confirmation
of the position of the tube can be obvious as the gastric content will automatically try to come
out through the nasogastric tube with a stool odor smell(Ricciuto et al., 2015). Where the gastric
content does not try to come out, administer 5mls of sterile water through the tube and aspirate.
Measure the pH of the aspirated content using a litmus paper(Shaikh, Patil, Mudali, Gafoor, &
Umminnisa, 2010). Gastric content is always acidic and so the color of the blue litmus paper is
expected to be red. Other than that, you can confirm whether the nasogastric tube is well inserted
by taking her to an X-ray. After confirming that the nasogastric tube is well inserted, secure the
tube and document all the procedures done for handing over(Weijs et al., 2017). Always confirm
if the nasogastric tube is inside the gastric region before performing any suction or handing over
to prevent any complication during care(Shaikh et al., 2010). Major nursing care for patients
with nasogastric tube includes confirming the tube is well inserted, performing oral care,
cleaning the tube area of suction and reporting any complication observed.

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Best Practice Techniques in Inserting an Indwelling catheter.
A Foley catheter is usually indicated for patients who have undergone surgery to allow
free and easy emptying of urine before covering. Since Mrs. O’ Reilly has undergone an elective
hip replacement surgery, she needs an indwelling catheter(Lee & Malatt, 2011). The insertion of
an indwelling catheter is a sterile procedure in order to prevent the contraction of urinary tract
infection(Cooper, Alexander, Sinha, & Omar, 2014). Evidence shows that the majority of the
patients have catheter-associated urinary infections due to two major reasons which include the
poor use of aseptic techniques during insertion and prolonged duration of stay with an indwelling
catheter. Therefore, in order to prevent catheter-associated urinary tract infection on Mrs.
O’Reilly, the sterile procedure should be applied(Shepherd, Mackay, & Hagen, 2017). Before
insertion, she should be informed about the procedure and why it is needed in order to obtain the
consent. After she accepted to be put an indwelling catheter, she should be well prepared by
positioning her well in a frog-leg pose(Lee & Malatt, 2011). Before insertion, dispense the
lubricating gel into the tray and add the cleansing solution over three cotton balls. After that,
remove the plastic sleeve from the catheter and put the syringes with sterile water into the port.
Inform the patient the need to give any complains when they feel uncomfortable during
the procedure. Using the dominant sterile hand, cover the catheter tip with the lubricant(Cooper
et al., 2014). Separate the labia using the non-dominant hand in order to make a good visual of
the meatus. Take one cotton wool ball with a forsept and wipe one side of the labia from the
bottom to up and discard the cotton ball away from the sterile field. Repeat the procedure to the
other side of the labia and take away the cotton ball away from the procedure field. Finally, wipe
down the middle using the third cotton wool ball and take it away from the sterile field(Shepherd
et al., 2017). After that, wipe all the areas with dry cotton wool balls. Insert the catheter for a

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length of around three inches and wait to see if the urine start to flow. If the urine starts to flow
insert one more inch and inflate the catheter using 10 ccs sterile of sterile water. After that,
empty all the urine in a urine port before connecting the catheter to the urine bag(Shepherd et al.,
2017). Make sure you cap the urine bag and the catheter is well attached. Inflating the catheter
should not be done using normal saline as it forms clots salts that can hinder its removal(Cooper
et al., 2014). Take precaution when, inflating the catheter and ask the patient to inform you of
any discomfort. This is to make sure no any other area is inflated like the urinary urethra. Always
use the sterile techniques at all time with the sterile equipment to prevent urinary tract infections.
Advocacy
Nursing care involves advocating for the patient’s rights in the course of treatment.
Nursing advocacy is defined as the process by which a nurse preserves human dignity, patients’
equality and freedom from suffering(National Collaborating Centre for Determinants of Health,
2015). A nurse plays a big role in caregiving. He or she communicates with the patients and their
relatives about their health and the procedures they will undergo. The nurse should explain to
Maria O’ Reilly’s process of nasogastric tube insertion, the advantages and possible
complications that are likely to result(Jansson, Nyamathi, Heidemann, Duan, & Kaplan, 2017).
By promoting patients equality nurse should realize that all patients are unique attend to them
unrestricted by social considerations, economic status, personal attributes or the nature of health
problems. Maria O’ Reilly’s condition is not an expectation and for this reason, requires should
be handled equally like other patients(Pandya & Myrick, 2013). Nursing as a profession involves
the desire to help others. He or she strives to free patients from suffering. This is achieved at
emotional, psychological and the physical levels. The patient, in this case, has a number of health

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problems, for instance, pain which is achieved by giving aspirin. In conclusion, a nurse should
strive to integrate all aspects revolving around patient care while at the same time upholding
standards. This is done through communication, liaisons, education, interpretation, and
caregiving.
Current Medications Rationales
Tenormin 50mg daily is a beta blocker drug type normally indicated for a high blood pressure of
which it is indicated in this patient due to the fact she has hypertension(Kim, Obara, & Johnson,
2015).
Aspirin 100mg daily is an anti-inflammatory drug that is usually indicated to patients who have
pain, fever or any information. However, in this case, scenario aspirin is indicated to Mrs.
O’Reilly to reduce the risk of stroke and a heart attack since she has currently undergone
surgery(Bullock, Galbraith, & Manias, 2013). This is due to the fact that, aspirin also acts as a
blood thinner thus it reduces blood clotting possibilities. Aspirin is contraindicated to patients
using frusemide
Metformin 500mg TDS is an antidiabetic drug that is normally indicated to patients with high
blood sugar. This drug is indicated to the patients since she has a history of type 2 diabetes
mellitus.
Frusemide 40mg daily is a loop diuretic drug that prevents the body from retaining much water.
It is indicated to this patient due to the fact that she has hypertension and mild congestive heart
failure. Furosemide is contraindicated to patients with high blood sugars.

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Potassium 600mg BD drug is a supplement that is usually indicated to patients with heart
problems. However, this drug has adverse effects such as vomiting and nausea(Kim et al., 2015)
Paracetamol 1G QID prn is antipyretic drug indicate for pain relief to the patient
Oxycodone 5 – 10mg 6/24ly prn is an opioid drug indicated for pain relief pain to the patient.
However, this drug is contraindicated to patients with bowel obstruction as it acts as a risk factor.
Metoclopramide 10mg 6/24ly prn is an antiemetic drug that is indicated to the patient since she is
vomiting. However, this drug is contraindicated to patients with hypertension, and intestinal
obstruction(Katzung, Masters, & Trevor, 2015).

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References
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