Nasogastric Tube Insertion and Complications

This nursing assignment focuses on the safe insertion of fine bore nasogastric tubes in adult patients. It emphasizes the importance of careful assessment, particularly considering neurological deficits, impaired blood clotting, tracheostomy, and GERD. The student must outline specific precautions to prevent complications like inadvertent tracheal intubation or esophageal erosion. The document also highlights the need for confirming tube placement after insertion and before administering food or medication.

Running head: NURSING CARE
Nursing Care
Name of the Student
Name of the University
Author Note

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NURSING CARE
Table of Contents
Part A.......................................................................................................................... 2
Nursing and Midwifery Board of Australia (NMBA)..................................................2
Australian Nursing and Midwifery Federation (ANMF)................................................2
Registration standard.............................................................................................. 2
Continuous Professional Development................................................................2
Criminal History....................................................................................................3
English Language................................................................................................ 3
Professional Indemnity.........................................................................................3
Recency of Practice.............................................................................................3
Enrolled Nurse Standards for Practice.................................................................3
Part B.......................................................................................................................... 5
Immediate Actions...................................................................................................5
Identified Learning Needs........................................................................................5
Future plans.............................................................................................................6
References..................................................................................................................7

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Part A
Nursing and Midwifery Board of Australia (NMBA)
The main function of the NMBA is to conduct proper registration process of
the nurses and midwifery practitioners. They are the sole body who develops nursing
standards, guidelines and codes of conducts for nursing and midwifery profession.
The code of professional conduct for nurses in Australia as defined by NMBA
furnishes 10 different standards, which the nurses need to abide by while working as
registered nurses in a healthcare institution. They also frame code of ethics for
nurses in Australia. There are 8 different codes, which instruct the nurse to practise
in an ethically competent manner. They also handle notifications, complaints, carry
out investigation and disciplinary hearings in the domain of nursing and nursing
profession related to healthcare. They also assess the overseas trained practitioners
who are interested in practising in Australian states. NMBA also holds rights to
approve the accreditation standards and courses of study under the nursing
profession. NMBA has also established state and territory boards in order to support
the work of the National Board under the national scheme. Here the National Board
will frame policies and nursing professional standards and on the other hand, the
state territory boards will continue their work to make separate notifications and other
registration decisions, which will affect the individual nurses and midwives. The
function carried by NMBA is supported by the Australian Health Practitioner
Regulation Agency (AHPRA), which also looks after the legislation governing the
nursing profession (Nursing and Midwifery Board of Australia - Home, 2017).
Australian Nursing and Midwifery Federation (ANMF)
ANMF is a special union that serves registered nurses, midwives and enrolled
nurses along with the assistants in the nursing who are serving nursing profession or
as nurse assistant in the sates or the territories legislated under Australia. It is the
largest union in Australia with more than 249,000 members. There are 8 different
branches of ANMF throughout Australia. The federal bodies of ANMF co-ordinates
the function of the branches in accordance to the national issues which are relevant
in the field of nursing profession. The rules framed by ANMF are directed towards
the organisation, membership, government, officers of the federation, finance,
industrial and legal matters and election of the federal officers. The rules are mostly
directly towards the promotion and protection of the interest of the members of the
ANMF. It also aims in improving the statutory and industrial rights of the nursing
profession for the betterment of the members. These rights included reform in
employment condition, high standard nursing practise along with professional
advancement in nursing domain (Thomas & Butler, 2017).
Registration standard
Continuous Professional Development
This registration standards frame the minimum requirement that is important
for the continuing professional development (CPD) among the midwives and the
enrolled and registered nurses. This registration standard is helpful for me because,
when I am serving as a nursing practitioner and holding an endorsement for
scheduled medicines, the as per the rule, I need to complete certain CPD

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requirements. There CPD requirement will help to increase my horizon of knowledge
regarding prescribing medicines, administration of medicines followed by diagnostic
investigations, proper consultation and referral. (Nursing and Midwifery Board of
Australia - Continuing professional development, 2017)
Criminal History
The registration standards in the domain of the criminal history in nursing care
is aimed in deciding whether the criminal history of a health care professional is
relevant with their professional life, or their tenure of practice under the health care
service. As per the registration standards in criminal history, one needs to judge the
nature and gravity of the offence committed by the health care personnel and its
relation with the health care practice before claiming his or her as guilty. It also helps
in determining whether a health care professional’s history is related to criminal
offense is properly documented. I will relate these standards in my future practice via
applying these rules in accessing the severity of the guilt committed by the
healthcare practitioner (Nursing and Midwifery Board of Australia - Criminal history,
2017).
English Language
According to NMBA, all the applicants during their initial registration are need
to demonstrate their English language skill and need to prove them to be suitable for
the registration. In order to attain success in the field of nursing career, I will attend
and then successfully complete a minimum six years of secondary and primary
language education in English. I will also make sure that my qualification and English
skills are relevant with my professional discipline in nursing. Shaping up my soft
skills in English language will help me to excel in my communication skills, one of the
important soft skills in the field of nursing profession (Nursing and Midwifery Board of
Australia - English language skills, 2017).
Professional Indemnity
This registration standard sets out minimal requirement in the field of
professional indemnity insurance (PII) arrangements in nursing profession. It
encompasses registered nurses, enrolled nurses and midwives. Under this
registration standard, I will make sure that when I will practice as a midwife or a
nurse, I will be covered under any third party PII arrangements that suffice all the
locations where I am aiming to practice, either it is private or government or s full
time or part-time. I will also ensure that my OII cover includes a civil liability,
automatic reinstatement and other retroactive cover. I will also ensure that I will not
practice healthcare profession unless and until my PII arrangements are amended in
relation to the healthcare profession (Nursing and Midwifery Board of Australia -
Professional indemnity insurance arrangements, 2017).
Recency of Practice
It sets out minimal requirement for the recency of practice under the banner of
the nursing profession. I will ensure that I have successfully completed my post
graduation degree in nursing and have a valid registration from well recognised
nursing regulatory authority before venturing into the professional nursing career
(Nursing and Midwifery Board of Australia - Recency of practice", 2017).

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Enrolled Nurse Standards for Practice
This legislation has been framed for the requirement of the endorsement as a
nursing practitioner under the section of 95 Health Practitioner Regulation National
Law. Under this registration, I will ensure that I am capable of demonstrating three-
years of full time experience with a successful completion of an NMBA approved
course, leading towards the program of endorsement along with proper compliance
with the NMBA’s nursing practise standards (Nursing and Midwifery Board of
Australia - Endorsement as a nurse practitioner, 2017). I will strictly obey the
standards because if I do not meet the standards, NMBA will refuse my registration
or endorsement.

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Part B
A fine bore nasogastric tube is defined as a narrow tube that is passed into
the stomach through the nasal cavities. It helps to support the nutritional needs of
the patients who are unable to maintain their normal nutritional value via oral intake
of food.
Immediate Actions
According to the Code of Professional Conduct for Nurses in Australia, nurses
must practise in a safe and competent manner and in accordance with the standards
of the profession and the broader health care system. So when I was asked to
replace and insert nasogastric tube, about which I am not aware off, I took help from
my senior registered nurse and then under her guidance I performed the task of
nasogastric tube insertion (Fine Bore Nasogastric Feeding Tubes for Adult Policy,
2017).
Identified Learning Needs
The specific skills and knowledge those are required while the insertion of
nasogastric tube includes: observation of patient’s condition before and after the
insertion of the nasogastric tube. Here the observation includes proper
documentation of the temperature, blood pressure, pulse, respiratory rate, oxygen
saturation. After the insertion of the nasogastric tube, the position of the tube must
be confirmed radiologically and the pH must be adequate that is < or equal to 5.
Moreover, if the patient is known to be suffering from the oesophageal varices or
severe coagulopathy then I will recommend the insertion of the nasogastric tube
under the presence of the experts of the radiology unit. For the patients who are
suffering from dry mouth, I will always moisten the mouth with the help of a moist
cotton bud prior insertion of the tube. In spite of taking preventive measures, the
procedure of nasogastric tube can turn out to extremely uncomfortable for the
patients. I will consider prescribing small amount of Lidnocaine gel inside the nostril
or spray the same medication on the back side of the throat to reduce the rate of
discomfort. However, before using Lindocaine gel, I will cross-verify whether the
patient has any reported cases of allergy with the Lidonocaine gel (Fine Bore
Nasogastric Feeding Tubes for Adult Policy, 2017).
During my course of work as Graduate Enrolled Nurse in acute medical ward,
I learnt the standard process of nasogastric tube insertion based on the guidelines of
NSW, Ministry of Health Australia. The patient must be postured in an upright
position with optimal head/neck alignment in order to assist insertion. Then the
nostrils need to be checked in order to detect any deformity in it and to determine
best side for the insertion. Then proper measurement needs to be done from the tip
of the nose to the earlobe and xiphisternum, the measurements must be done in cm
and must be simultaneously marked in the tube. After measurements, the tube must
be lubricated and then passed via nostrils and then the positioning is checked via
radiograpy. If the patient is found coughing or experiencing breathing problem then
the entire setup needs to be uninstalled. However, absence of coughing does not
necessarily rules out the condition of misplacement of the tube (Fine Bore
Nasogastric Feeding Tubes for Adult Policy, 2017)..

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I learnt that incorrect insertion of the nasogastric tube can lead to trauma in
the surrounding areas along with occurrence of pneumothorax in extreme cases.
Other threats include aspiration associated with the process of tube dislodgement
and appearance of condition like pneumonitis when the nasogastric feeds get
deposited into the pulmonary cavities. At times, misplacement of tubes can occur,
mainly inside the lungs and is common in patients with cribriform plate disruption,
intracranial insertion (Fine Bore Nasogastric Feeding Tubes for Adult Policy, 2017).
Future plans
During my future course of work with nasogastric tube, I will keep in mind that
the patients who are critically ill are at an increased risk of getting affected with the
nasogastric tube complications for example the patients who are suffering from
neurological deficits. Moreover, I will also try to remain alert while inserting fine bore
nasogastric tube into a patient with low or zero reflexes, as fractional negligence in
this ground can cause accidental insertion of the tubes into other adjoining
anatomical structures. I will also exercise caution while inserting nasogastric tube in
patients with impaired blood clotting and are on anticoagulant medication. The same
measure of caution goes with the patients who are suffering from tracheostomy
because there is always lays a risk factor of inadvertent tracheal intubation. Last but
not the least, a fine bore nasogastric tube may lead to leakage of the gastric
contents from the stomach causing fatal oesophageal erosions with patients who are
diagnosed with gastro-oesophageal reflux disease (GERD). So before insertion, I will
cross-check the nasogastric tube properly and will also refrigerate the nasogastric
tube before insertion (Fine Bore Nasogastric Feeding Tubes for Adult Policy, 2017).
I will also recheck nasogastric tube position after the initial insertion, before
administration of food or medication in order to side-pass unwanted complications.

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References
Fine Bore Nasogastric Feeding Tubes for Adult Policy. (2017) (pp. 1 to 8). Australia.
Retrieved from http://www1.health.nsw.gov.au/pds/ActivePDSDocuments
Lee Thomas, A., & Annie Butler, A. (2017). Australian Nursing & Midwifery
Federation. Anmf.org.au. Retrieved 31 October 2017, from http://anmf.org.au/
Nursing and Midwifery Board of Australia - Continuing professional development.
(2017). Nursingmidwiferyboard.gov.au. Retrieved 31 October 2017, from
http://www.nursingmidwiferyboard.gov.au/Registration-Standards/Continuing-
professional-development.aspx
Nursing and Midwifery Board of Australia - Criminal history.
(2017). Nursingmidwiferyboard.gov.au. Retrieved 31 October 2017, from
http://www.nursingmidwiferyboard.gov.au/Registration-Standards/Criminal-
history.aspx
Nursing and Midwifery Board of Australia - Endorsement as a nurse practitioner.
(2017). Nursingmidwiferyboard.gov.au. Retrieved 31 October 2017, from
http://www.nursingmidwiferyboard.gov.au/Registration-Standards/Endorseme
nt-as-a-nurse-practitioner.aspx
Nursing and Midwifery Board of Australia - English language skills.
(2017). Nursingmidwiferyboard.gov.au. Retrieved 31 October 2017, from
http://www.nursingmidwiferyboard.gov.au/Registration-Standards/English-
language-skills.aspx
Nursing and Midwifery Board of Australia - Home. (2017).
Nursingmidwiferyboard.gov.au. Retrieved 31 October 2017, from
http://www.nursingmidwiferyboard.gov.au/
Nursing and Midwifery Board of Australia - Professional indemnity insurance
arrangements. (2017). Nursingmidwiferyboard.gov.au. Retrieved 31 October
2017, from http://www.nursingmidwiferyboard.gov.au/Registration-
Standards/Professional-indemnity-insurance-arrangements.aspx
Nursing and Midwifery Board of Australia - Recency of practice.
(2017). Nursingmidwiferyboard.gov.au. Retrieved 31 October 2017, from
http://www.nursingmidwiferyboard.gov.au/Registration-Standards/Recency-of-
practice.aspx