1. 2. 3. 4. 5. 6. 7.

8. 9.

10.

11.

12.

13. 14.

Check physicians order for insertion of nasogastric tube. Explain procedure to patient. Gather equipment. If nasogastric tube is rubber, place it in a basin with ice for 5 to 10 minutes or place a plastic tube in a basin of warm water if needed. Assess patients abdomen. Perform hand hygiene. Don disposable gloves. Assist patient to high Fowlers position or to 45 degrees if unable to maintain upright position and drape his or her chest with bath towel or disposable pad. Have emesis basin and tissues handy. Check nares for patency by asking patient to occlude one nostril and breathe normally through the other. Select nostril through which air passes more easily. Measure distance to insert the tube by placing tip of tube at patients nostril and extending to tip of earlobe and then to tip of xiphoid process. Mark tube with a piece of tape. Lubricate tip of tube (at least 1-2 inches) with watersoluble lubricant. Apply topical analgesic to nostril and oropharynx or ask patient to hold ice chips in his or her mouth for several minutes (according to physicians preference). After having the patient lift his or her head, insert tube into nostril while directing tube downward and backward. Patient may gag when tube reaches the pharynx. Instruct patient to touch his or her chin to chest. Encourage him or her to swallow ever if no fluids are permitted. Advance tube in a downward-andbackward direction when patient swallows. Stop when patient breathes. Provide tissues for tearing or watering eyes. If gagging and coughing persist, check placement of tube with a tongue blade and flashlight. Keep advancing tube until tape marking is reached. Do not use force. Rotate tube if it meets resistance. Discontinue procedure and remove tube if there are signs of distress, such as gasping, coughing, cyanosis, and inability to speak or hum. Determine that tube is in patients stomach. Hold tube in place to keep it from withdrawing while placement is checked.

2. 3.

4. 5. 6.

Place unsplit end over bridge of patients nose. c. Warp split ends under tubing and up and over onto nose. Attach tube to suction or clamp tube and cap it according to physicians orders. Secure tube to patients gown by using a rubber band or tape and a safety pin. If double-lumen tube is used, secure vent above atomach level. Attach at shoulder level. Assist or provide patient with oral hygiene at regular intervals. Perform hand hygiene. Remove all equipment and make patient comfortable. Record the insertion skill, type, and size of tube and measure tube from tip of nose to end of tube. Also document description of gastric contents, which naris used, and patients response.

b.

ABG Ph 7.35 - 7.45 PCO2 35 45 mm Hg HCO3 22 27 mEq/ml PO2 80 100 mm Hg SaO2 93 100% RBC Male 4.5 - 6.2 million/ cubic mm Female 4.0 - 5.5 million/cubic mm WBC 4,300 - 10,800/ cubic mm Platelets 150,000 - 350,000/ cubic mm Hgb Male 14 - 16.5 g/dL Female 12 - 15 g/ dL Hct Male 42 - 52%

1. Attach syringe to end of tube and aspirate a small amount of stomach contents. b. Measure pH of paper or a meter. c. Visualize aspirated contents, checking for color and consistency. d. Obtain radiograph of placement of tube (as ordered by physician). Apply tincture of benzoin to tip of nose and allow to dry. Secure tube with tape to patients nose. Be careful not to pull tube too tightly against nose. a.

Female 35 - 47% PT (Warfarin/ Coumadin) Male 9.6-11.8 secs Female 9.5-11.3 secs Should be 1.5 to 2 times the Normal PTT/ APTT (Heparin) 20-36 secs / 30-45 secs Should be 1.5 to 2.5 times the Normal

2.

1. a. Cut a 4-inch piece of tape and split bottom 2 inches or use packaged nose tape nasogastric tubes.

INR 2 3 Standard Warfarin therapy

3 4.5 High dose Warfarin therapy 2-3 Atrial fibrillation, DVT and Pulmonary embolism 2.5-3.5 Prosthetic heart valves Bleeding Time 3 - 7 mins. 8 - 15mins (Saunders) Electrolytes K 3.5 - 5.1 mEq/ L Mg 1.6 - 2.6 mEq/ L Ph 2.7 - 4.5 mEq/ L Na 135 - 145 mEq/ L Cl 98-107 mEq/ L Ca 8.6 - 10 mg/dL Potassium Chloride IT IS NEVER GIVEN BY IV PUSH, IM OR SUB Q With a dilution of not more than 1mEq/10ml Maximum infusion rate of 5-10 mEq/ hr NEVER to exceed 20 mEq/ hr at any circumstance Blood Sugar 70 110 mg/dL Glycosylated Hgb (glycohemoglobin) less than 7.5% Good 7.6 - 8.9% Fair greater than 9% Poor Vanillylmandelic Acid (VMA) 0.7 - 6.8 mg/24 hrs GFR 125 ml/min Creatinine 0.8 - 1 mg/dL 0.6-1.3 mg/dL (Saunders) BUN 10 20 mg/dL 8-25 mg/dL (Saunders) UO Adult: 30 cc/hr and 720 cc/24 hours Pedia: 2cc/ kg/ hr AST/ ALT 5-40 IU/L

Ammonia 9-33 mol/L 35-65 mcg/ dl Albumin 3 - 5 g/dL Amylase 25-151 units/ L Lipase 10-140 units/ L Bilirubin (Total) less than 1.5 mg/ dL Pulmonary capillary mean wedge pressure 4-12 mmHg Central Venous Pressure 2-6 mmHg Plasma Osmolality 280-300 mOsm/kg Serum Alcohol LEGAL .08 - .10 TOXIC! grater than 0.15 (50mg/100cc of blood) greater than 8%