Nursing care plan question, Nasogastric tube

[Possum_RN]

Hello, all! I'm a new user :)

I'm working on my care plan, and I have a question about nasogastric tube placement. First, some patient background:

Patient admitted on previous day for Abd. pain. CT scan showed "dilated loops of small bowel", and diagnosis of small bowel obstruction was made. Patient was referred for surgical consultation and was NPO. Patient had Hx of diverticulitis, and had previous bowel resection. An NG tube was placed, and then replaced by me when it came out.

My question is, besides risk of fluid-volume deficit, is there another nursing diagnosis that applies for an NG tube? Risk of impaired skin integrity, perhaps? I always see risk of aspiration care plans, but that just does not strike me as applicable here.

I'm sure i'll have this done and turned in before I get any replies, so no worries about feeding me answers....I was just curious.

[amoLucia]

Just my opinion, but ASPIRATION RISK is always a possibility whenever an NG tube is inserted. ALWAYS! I'm assuming the tube is hooked to suction.

1 - Those things can slide and then OOPS!

2 - Pt positioning is always paramount.

They freq are uncomfortable.

If your pt is A&O, sometimes it's miserable when the roommate receives a tray and food aroma wafts over to the tubed pt. It's like a deprivation.

[kaylee.]

Agree with PP. Risk of aspiration is not only applicable, but its a PRIORITY.

Dont try to think up diagnoses from nothing, think of actual care and priorities then pull the diagnosis from that.

Also think about the urgency of the problem: you mention skin integrity, something that is gradual and not posing immediate threat. Aspiration is a more immediate and threatening complication. Think ABCs. If someone is rapidly developing acute resp failure skin integrity is the LAST thing on your mind.

The ndx has always seemed confusing to me...

[Possum_RN]

Hmm....I guess i'm just still confused about it all. The patient was NPO, and alert and oriented x4. The nasogastric tube was placed, to prevent aspiration. I guess the fact that it became dislodged put him at risk? I'm just not getting it, and I guess I need to research more.

I did address it somewhat in one of my three priority problems - risk for infection r/t invasive drains and inflammatory condition of bowel. Hope that was enough :/

[SopranoKris, MSN, RN, NP]

Think of nursing diagnoses as what you *anticipate* could happen when using the "Risk For" designation. What is the most immediate concern and/or risk for this pt. For this patient, the most immediate concern (as it relates to nursing, not medical diagnosis) is the possibility of the NG tube becoming dislodged and the pt aspirates. You mentioned the NG tube had already become dislodged and had to be removed already. This definitely elevates the risk that it could happen again. That's why Aspiration Risk will be one of your top priorities for this pt.

As the previous posters said above, you need to think if anything related to ABCs applies first.

[AliNajaCat]

You don't "choose" or "pick" a nursing diagnosis "for" a piece of equipment. You make a nursing diagnosis of your patient based on your patient assessment.

Step back and take a deep breath.

What did you assess about your patient that would lead you to planning some nursing intervention to address it?

[jj224]

The aspiration risk for this patient isn't from the NG tube, it's from the small bowel obstruction. If you're looking for something specific for the NG tube, skin breakdown, nose bleed, etc.