A client with a laryngectomy returns from surgery with a nasogastric tube in place, the primary reason for placement of the nasogastric tube is to?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

Following a laryngectomy, a nasogastric (NG) tube is inserted to provide a route for enteral nutrition while the patient is kept NPO (nothing by mouth).
This bypasses the surgical site in the pharynx, preventing food, fluid, and saliva from coming into contact with the fresh suture line.
The primary goal is to keep the area clean and at rest, which significantly reduces the risk of serious complications like infection, wound dehiscence (breakdown), and pharyngocutaneous fistula formation.

Option A: The NG tube does not prevent swelling (edema) or dysphagia (difficulty swallowing). Swelling is an expected inflammatory response managed with positioning and medication. The tube is placed because the patient has dysphagia and cannot swallow safely.
Option B: While NG tubes can be used for decompression, this is not the primary reason after a laryngectomy. The main goal is to protect the neck suture line, not to manage gastric contents.
Option D: The primary surgical site is in the larynx and pharynx, not the oral cavity. The NG tube's purpose is to protect this deeper surgical area.

Clinical Relevance

Nursing practice connection: Use the key finding related to Postoperative management following a laryngectomy and the specific indication for a nasogastric (NG) tube to guide bedside assessment, documentation, and the next nursing action.
The most critical nursing responsibility is to ensure the NG tube is not manipulated or reinserted if it becomes dislodged. Blind reinsertion can perforate the fresh suture line, a life-threatening complication. The surgeon must be notified immediately.
Nurses must monitor for signs of a pharyngocutaneous fistula, such as saliva leaking from the neck incision, redness, or fever, which indicates a breakdown of the surgical repair.
What if? If a patient with a post-laryngectomy NG tube develops signs of respiratory distress, the nurse's first action is to assess airway patency (e.g., by suctioning the tracheostomy tube), as the NG tube itself does not affect the new, separated airway.

How to Approach the Question

First, identify the core elements of the question: a patient post-laryngectomy with an NG tube, and the 'primary reason' for it.
Recall the major goals of postoperative care for this specific surgery. A laryngectomy involves significant reconstruction in the throat, creating a suture line that separates the airway from the digestive tract.
Consider the greatest risk: breakdown of this suture line. This could lead to aspiration, infection, and fistula.
Evaluate each option based on this primary risk. An NG tube allows feeding without using the throat for swallowing.
Conclude that the tube's main purpose is to protect the healing suture line by bypassing it for nutrition, which directly corresponds to preventing contamination.

Concept Tested & Keywords

Concept Tested: Postoperative management following a laryngectomy and the specific indication for a nasogastric (NG) tube.
Stem keywords: laryngectomy, nasogastric tube, primary reason, post-surgery
Lead-in keywords: primary reason
Negative lead-in flag: false

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E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 p. 50-52

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 43-45

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.