A patient with pneumonia requires NG tube suctioning for airway secretion management. Which of the following is the correct sequence of nursing actions?

Appeared in: NORCET 10 Mains

Explanation

The first step is to position the patient upright (semi-Fowler's) to facilitate breathing, promote effective coughing, and prevent aspiration of secretions.
Next, the patient is hyperoxygenated with a facemask to increase oxygen reserves in the lungs, which helps prevent hypoxemia during the procedure.
The suction catheter is then inserted into the nasotrachea without applying suction. This is a critical safety measure to prevent trauma to the delicate mucous membranes of the nasal passage and trachea.
Finally, intermittent suction is applied only after the catheter is correctly positioned and during its withdrawal. This process should not exceed 10-15 seconds per pass to minimize oxygen depletion.

Option A: This option is incorrect because it initiates suction first, which is ineffective before the catheter is inserted and can cause significant mucosal trauma and hypoxia.
Option B: This option is incorrect as it fails to prepare the patient. Skipping positioning and pre-oxygenation places the patient at high risk for aspiration and severe hypoxia.
Option D: This option is incorrect because it applies suction before the catheter is properly positioned and inserted into the trachea, violating a primary safety rule of the procedure.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Correct procedural sequence for nasotracheal suctioning in acute care settings.
Proper suctioning technique is a critical nursing skill to maintain airway patency and prevent life-threatening complications like atelectasis and respiratory failure in patients unable to clear their own secretions.
Incorrect sequencing or technique can lead to serious adverse events, including hypoxia, cardiac arrhythmias, tracheal mucosal damage, and healthcare-associated infections.
What if? If the patient's SpO2 drops below 90% or their heart rate drops by more than 20 bpm during the procedure, the nurse must immediately stop suctioning, withdraw the catheter, and administer 100% oxygen.

How to Approach the Question

This is a process-based question requiring you to know the correct order of a nursing procedure.
First, identify the goal: safe and effective airway suctioning.
Apply the principle of 'patient preparation first.' This means positioning the patient for safety and providing oxygen must happen before any invasive action.
Recall the key safety rule: never apply suction during catheter insertion to prevent tissue damage. Suction is only for withdrawal.
Evaluate each option against this logical flow: Prepare Patient -> Insert Catheter -> Apply Suction. Only one option will match this safe sequence.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 13-15

E6 Nursing Fundamentals Taylor p. 745-747

Practise the full NORCET 10 Mains

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