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

Running head: NURSING ASSIGNMENT 1
Case Scenario
(Author’s name)
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NURSING ASSIGNMENT 2
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

NURSING ASSIGNMENT 3
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

NURSING ASSIGNMENT 4
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.