Question

A 68 y/o female is admitted to your unit. She has difficulty swallowing and is on oxygen at 3 L/min per nasal cannula. She has coarse rales bilaterally with expectoration scant yellowish sputum. She is 5'6" and weighs 110 pounds. She has been nauseated and no appetite the last 3 days. Her color is pale, and skin is dry. She states she is "tired and weak". 1. At the beginning of the shift, what would be the priority assessment on this client? a. O2 saturation level b. Nutrition level c. Time of last bowel movement d. If she feels rested 2. The client is choking when trying to swallow food. What type of diet would the health care provider order? a. Clear liquid b. Full liquid meal with a thickener c. Mechanical soft d. Diet as tolerated 3. The doctor orders a nasogastric (NG) tube be inserted. You have collected the materials for the procedure. In what order should you proceed? 1. X-Ray for placement 2. Measure tube from nose to ear to stomach 3. Tape tubing around nostril 4. Place in high Fowlers 5. Advance tube as client swallows a. 4, 2,5, 3, 1 b. 2, 5, 4, 3. 1 c. 2, 3, 4, 5, 1 d. 3, 4, 5, 1, 2

Answer 1

1.The patient has an oxygen delivered through nasal cannula ,so the most priority assessment should be checking the oxygen saturation. Checking or assessment of last bowel movement will be last,after the nutritional status is assessed,In simpe when a handover is taken the patient's overall status of restful or restlessness are first assessed. Any changes in this indicates a need of medical help

Ans:d .if she feels rested

2.Clear liquid diet has a high chance of aspiration in patient who has swallowing problems.Full liquid diet with thickener can make chewing difficult. Diet as tolerated will be prescribed only when patient tolerates other form of foods.A mechanical soft diet is a pureed or completely mashed form of food which is prescribed for patient's who are unable to swallow or chew the food.

Ans:c. Mechanical soft

3.Nasogastric tube is inserted through the mares and rests innthe stomach. This is indicated to patients who cannot swallow foods .The type of food delivered is liquid diet.The following thing has yo be fone before inserting the tube

• Hand hygiene
• Fowler position or head end elevated to 45°or 90°
• Inspect the nares for obstruction, abdomen for distension etc.,
• Measure from ear lobe to tip of nose to xiphoid  process
• Lubricate the tip of ng tube
• Gently insert through the nares
• When it reaches the pharyn the patient gag reflex is stimulated and pati ent starts coughing, encourage to swallow saliva or provide sips of water and advance the tube
• Check by auscultation, bubble method
• Fix it in the nose with tapes
• Place patient in comfortable position
• Confirm position with chest X Ray
• Remove all articles
• Hand hygiene
• Documentation

Ans:a.4,2,5,3,1