The nurse is inserting nasogastric tube to a client, tube is inserting gently downwards and it reached nasopharynx and there is slightly resistance occurs. What would be the nurse's next action?

1. A

   Withdraw the tube

2. B

   Wait for 5 minutes and further insert the tube

3. C

   Instruct the patient to swallow or engulf

4. D

   Notify the physician

Appeared in: NORCET -4 , 2023

Explanation

Listen in Hindi

• When the nasogastric tube reaches the posterior nasopharynx, it is at a natural anatomical curve.
• Instructing the patient to swallow (often with sips of water) facilitates the passage of the tube.
• The act of swallowing causes the epiglottis to close over the trachea, preventing the tube from entering the airway.
• Simultaneously, swallowing opens the upper esophageal sphincter, guiding the tube correctly into the esophagus.
• This is a standard and expected step in the procedure to ensure safe and effective tube placement.

Why Other Options Were Wrong

• Option A: Withdrawing the tube is not the correct response to slight, expected resistance. This action is reserved for signs of respiratory distress (e.g., severe coughing, choking, cyanosis), which indicate the tube has entered the airway.
• Option B: Simply waiting for five minutes is ineffective. It does not change the patient's anatomy or help the tube advance. It only prolongs patient discomfort and the duration of the procedure.
• Option D: Notifying the physician is premature. Managing slight resistance during NG tube insertion is a fundamental nursing skill and within the nurse's scope of practice. Escalation is not required for expected findings.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Procedure for Nasogastric (NG) Tube Insertion to guide bedside assessment, documentation, and the next nursing action.
• Correctly navigating the nasopharynx is a critical step for patient safety during NG tube insertion. Improper technique can lead to inserting the tube into the trachea, which can cause pneumonia, pneumothorax, or even death if fluids are administered.
• Nurses must be able to differentiate between expected resistance at the nasopharynx and signs of airway misplacement (coughing, choking, inability to speak).
• What if? If the patient starts to cough and gag but can still speak and is not cyanotic, the nurse should pause advancement, pull the tube back slightly until the coughing subsides, and then re-instruct the patient to swallow as they advance the tube again. If coughing becomes violent or is accompanied by signs of respiratory distress, the tube must be withdrawn immediately.

How to Approach the Question

• First, identify the procedure being performed: Nasogastric (NG) tube insertion.
• Pinpoint the specific event in the question: The tube has reached the nasopharynx and met slight resistance.
• Recognize this event as a common and expected part of the procedure due to the anatomy of the pharynx.
• Recall the standard nursing intervention for this specific step. Think about the physiology: what action helps the tube pass from the pharynx into the esophagus safely?
• Evaluate the options based on this knowledge. The action of swallowing closes the airway (trachea) and opens the food pipe (esophagus).
• Eliminate options that are incorrect for this specific situation: withdrawing is for complications, waiting is ineffective, and notifying the physician is premature.

Concept Tested & Keywords

• Concept Tested: Procedure for Nasogastric (NG) Tube Insertion
• Stem keywords: nasogastric tube, inserting, nasopharynx, resistance
• Lead-in keywords: next action
• Clinical cues: Slight resistance at nasopharynx is a key finding, indicating a normal anatomical point, not a complication.

Question ID

Qu945DXtTSKUjRPWJk8feJ

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor p. 668-670

E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 54-56

E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 217-219