PAMANTASAN NG LUNGSOD NG MAYNILA

COLLEGE OF NURSING

Medical- Surgical Nursing II

SKILLS LABORATORY CHECKLIST

BUENO, Jessa Mae D

Name: ______________________________________ February 28, 2024
Date: ______________________________
3-8
Year Level and Block: _______________________ Prof. Dimasuay
Clinical Instructor: ___________________

Rating scale:

3 Performed correctly, systematically according to standard with correct rationale.

2 Performed correctly, with correct rationale but not systematic.
1 Performed correctly, but not systematic and with inadequate rationale.
0 Performed incorrectly.

Procedure: Inserting a Nasogastric/ Nasointestinal Tube

PREPARATION RATIONALE PERFORMANCE REMARKS
3 2 1 0
Purpose
• Permits nutritional support through To administer tube feedings and
GI tract. medications to clients unable to eat by
mouth or swallow a sufficient diet
without aspirating food or fluids into the
lungs.

• Allows evacuation of gastric contents. To remove stomach contents for

laboratory analysis

• Relieves nausea. To establish a means for suctioning

stomach contents to prevent gastric
distention, nausea, and vomiting.

Assessment:
• Doctor’s order for type and use of To ensure the patients receive the correct
tube treatment. Check appropriate orders
relevant to patient safety.

• Size of previous tube used if any Knowing the size of previous NG tubes
history of GI problems requiring use used in patients with a history of GI
problems helps ensure optimal comfort,
of tube.
treatment efficacy.

• History of nasal or sinus problems To anticipate complication, assess

obstruction risks, and consider
alternative routes.

• GI status, including nausea, vomiting Pre-checking GI status optimizes

or diarrhea; bowel sounds; patient outcomes and procedural
 abdominal distension or girth: success while minimizing risks.
passage of flatus.

• history of nasal surgery or deviated It allows to anticipate challenges

septum. and implement appropriate
techniques to ensure safe and
successful NG tube placement,
minimizing patient discomfort and
reducing the risk of complications.

• Patency of nares. To know if the patient is at risk for

complication, to avoid the nasal route.

Absence of Gag reflex is a indication for

• Presence of gag reflex.
NGT insertion. Because once absent the
patient may suffer from aspiration

• Mental status or ability to cooperate Patient must be able to follow

with the procedure. instructions related to NG insertion to
allow for passage of tube through nasal
and gastrointestinal tracts.

Assemble equipment and supplies: This provides for an organized

• NG tube (14-18 French) or approach to task.
nasoinstestinal small bore feeding
tube (8-12 French)
• Non allergenic adhesive tape, 2.5 cm
(1 inch) wide
• Nonsterile gloves
• Water soluble lubricant
• Facial tissue or towel
• Glass of water and drinking straw or
ice chips
• 30-60 ml syringe with an adapter or
asepto syringe
• Emesin Basin
• Ph test strip
• Stethoscope
• Disposable pad or towel
• Pen
Procedure
1. Introduce yourself and verify the client's To ally anxiety and providing the right
identity. Explain to the client what you information may result to client’s
are going to do, why it is necessary, and cooperation and understanding
how the client can cooperate.

2. Perform hand hygiene and provide for To prevent the transmission of

client privacy. microorganisms.
3. Lower siderails and place the client in This helps prevent biomechanical injury
semi or high fowler’s position to the health care provider. Positioning in
high fowler’s allows easier to swallow

4. Check for nasal patency: To ensure optimal tube placement,

• Ask the client to breathe through minimizing discomfort and
one naris while the other is reducing the risk of complications
occluded. Repeat with other naris such as nasal trauma or
misplacement during the
procedure.
.
Removing excess mucus and
• Have with both a client blow nose
secretions reduces the risk of tube
with both nares open. Clean mucus
obstruction and enhances patient
and secretions from nares with
moist tissues or cotton tipped swabs comfort during the procedure.

5. Prepare Tube
• Measures length of tubing needed This length approximates the distance
by using tube and measure distance from the nares to the stomach. This
from tip of nose to earlobe and then distance varies among individuals.
from earlobe to sternal notch. Mark
the location on the tubing with a
small piece of tape.
This allows the tubing to become more
• If necessary, place tube in ice-water pliable and flexible. However, if the
bathe softened tube becomes difficult to
control, it may be helpful to place the
distal end in a basin of ice water to help it
hold its shape

• If a feeding tube with weighted tip is An improperly positioned stylet or

used (small bore feeding tube), guidewire can traumatize the
measure for distance as instructed nasopharynx, esophagus, and stoma
with package insert. Insert guide
wire and prepare the tube as
instructed on package insert (usually
by flushing with10-20ml of saline
irrigation solution).
6. Don gloves and use water soluble To prevent transmission of
lubricant or dip feeding tube in water to microorganism. A water-soluble lubricant
lubricate tip. dissolve if the tube accidentally enters
the lungs. An oil-based lubricant, such as
petroleum jelly, will not dissolve and
could cause respiratory complications if it
enters the lungs.

7. Ask client to tilt head backward; insert Hyperextension of the neck reduces the
tube into clearer naris. curvature of the nasopharyngeal junction
8. As the tube advanced, have client hold Dropping the head forward closes the
head and neck straight and open mouth trachea and opens the esophagus, which
allows the NG tube to pass more easily
through the nasopharynx and into the
stomach.

9. When tube is seen and client can feel Tilting the head forward facilitates
tube in pharynx, instruct client to passage of the tube into the posterior
swallow (offer ice chips or sips of water, pharynx and esophagus rather than into
unless contraindicated) the larynx; swallowing moves the
epiglottis over the opening to the larynx

10. Continue to advance tube further into The tube should never be forced against
esophagus as client swallows (if client resistance because of the danger of
coughs or tube curls in throat, withdraw injury.
tube pharynx and repeat attempts);
The tube may be coiled in the throat. If
between attempts, encourage client to
so, withdraw it until it is straight, and try
take deep breaths.
again to insert it.
11. When tape mark on the tube reaches
entrance to naris, stop tube intersection
and check placement by:
to ensure that the tube is directed
• Having client open mouth for tube toward the esophagus rather than
visualization. the trachea.

• Aspirating with syringe, nothing color Testing pH is a reliable way to determine

of secretion return, and checking pH location of a feeding tube. Gastric
of drainage (pH between 1 and 5 contents are commonly pH 1 to 5; 6 or
greater would indicate the contents are
may indicate gastric secretions; pH of
from lower in the intestinal tract or in the
7 or higher may indicate intestinal respiratory tract
placement) or for old tube feeding (if
reinsertion).
12. Secure tube by attaching commercially
prepared tube holder by:
• Splitting 2 inches of long tape strip, Taping in this manner prevents the tube
leaving 1 inch of strip intact from pressing against and irritating the
• Applying 1 inch base of tape on edge of the nostril
bridge of nose
• Wrapping first one and then the
other side of split tape around tube.
13. Tape loop of tube to side of client’s face The tube is attached to prevent it from
(if feeding tube) or pin to client’s gown (if dangling and pulling
sump tube).
14. Obtain order for chest x-ray; delay tube This precaution helps prevent
feeding or flushing with fluid until doctor complications. Waiting for
reads x-ray. confirmation from the chest x-ray
ensures patient safety by verifying
the appropriate positioning of the
NGT before initiating enteral
 feeding.

15. Store stylet from small-bore feeding tube Storing the stylet from a small-bore
in a plastic bag at the bedside after feeding tube in a plastic bag at the
correct placement is confirmed by x-ray. bedside after confirming correct
placement ensures accessibility,
prevents contamination, and
streamlines the procedure.

16. Begin suction or tube feeding as ordered. Simultaneously initiating suction

or tube feeding ensures
continuous management of the
patient's condition.

17. Restore or discard all equipment to maintain patient safety and

appropriately prevent infection

18. Reposition client for comfort. to enhance patient well-being and

minimize discomfort

19. Remove and discard gloves and perform This reduces the transmission of
hand hygiene. microorganisms.

20. Document all relevant information.

• Date and time of tube insertion. 28/02/24 1030 #14 Fr feeding tube
• Color and amount of drainage return inserted without difficulty through R
• Ph result nares with stylet in place. To x-ray to
check placement. Radiologist reports
• Size and type of tube
tube tip in stomach. Stylet removed.
• Client tolerance of procedure
Aspirate pH 4. Tube secured to nose. Pt.
• Confirmation of tube placement by x- verbalizes understanding of need to not
ray. pull-on tube. –––––––––– J. BUENO, RN
• Suction applied (amount) or tube
feeding started and rate.

________________________________
Signature over Printed Name of Student

Evaluated By:

________________________________
Signature over Printed Name
Clinical Instructor
 PAMANTASAN NG LUNGSOD NG MAYNILA
COLLEGE OF NURSING

Medical- Surgical Nursing II

SKILLS LABORATORY CHECKLIST

BUENO, Jessa Mae D

Name: ______________________________________ February 28, 2024
Date: ______________________________
3-8
Year Level and Block: _______________________ Prof. Dimasuay
Clinical Instructor: ___________________

Rating scale:

3 Performed correctly, systematically according to standard with correct rationale.

2 Performed correctly, with correct rationale but not systematic.
1 Performed correctly, but not systematic and with inadequate rationale.
0 Performed incorrectly.

Procedure: Removing a NG tube

PREPARATION RATIONALE PERFORMANCE REMARKS

3 2 1 0
1. Assess:
• For the presence of bowel Checking the presence of bowel
sounds. sounds before removing the NG
tube is to ensure that the
gastrointestinal tract is functioning
normally.

• For the absence of nausea or Clamping the tube prevents any

vomiting the tube is clamped. gastric contents from moving up
the esophagus and reduces the
risk of aspiration during the
removal process.

2. Assemble equipment and supplies. Having the necessary equipment

• Disposable pad or towel on hand ensures a hygienic and
• Tissues efficient procedure.
• Clean gloves
• 50ml syringe
• Plastic trash bag
3. Confirm the doctor’s order for removal Following medical orders ensures
of NGT patient safety and compliance with
treatment plans.
4. Assist the client to a sitting position if not Positioning the patient upright
contraindicated helps facilitate a smoother removal
process and minimizes discomfort.

5. Place the disposable pad or towel across To collect any spillage of mucous and
the client’s chest. gastric secretions from the tube

6. Provide tissues to the client to wipe nose This clears the nares/nasal passages
and mouth after tube removal. of any remaining secretions

Procedure
1. Introduce yourself and verify the Patient understanding and
client's identity. Explain to the client cooperation facilitate a smooth
what you are going to do, why it is procedure and reduce discomfort.
necessary, and how the client can
cooperate
2. Perform hand hygiene This reduces the transmission of
microorganisms.

3. Provide privacy Respects the patient's dignity and

reduces potential embarrassment,
promoting their comfort and
cooperation during the procedure.

4. Detach the tube.

• Disconnect the NGT from the Prevents accidental suctioning of
suction apparatus if present. gastric contents or respiratory
secretions, reducing the risk of
aspiration or respiratory distress.

• Unpin the tube from the Removing the pin ensures that the
client’s gown. tube can be smoothly and safely
withdrawn without any obstruction
or pulling on the gown.

• Remove the adhesive tape Removing the tape allows for

securing the tube on the nose easier and safer removal of the NG
tube

5. Remove the NG tube.

• Put on clean gloves To prevent transmission of
microorganism

. This closes the glottis, thereby

• Ask the client to take a deep preventing accidental aspiration of
breath and to hold it. any gastric ccontent.
 • Pinch the tube with the
gloved hand. Pinching the tube prevents any
contents inside the tube from
draining into the client’s throat

• Smoothly withdraw the tube.

Slow, steady removal reduces
discomfort and minimizes the risk
of injury to the nasal passages or
throat.
• Place the tube in the plastic
bag. Placing the tube immediately into the
bag prevents the transference of
microorganisms from the tube to
other articles or people
• Observe the intactness of the
tube. Removing a damaged tube
prevents potential harm to the
patient during removal.
6. Ensure client comfort.
• Provide mouth care, if lows patients to alleviate dryness,
desired. remove any residual taste or
sensation associated with the tube
insertion

Excessive secretions may have

• Assist the client as required to accumulated in the nasal passages.
blow nose
7. Dispose of the equipment
appropriately. Correct disposal prevents the
• Place the pad, bag with tube and transmission of microorganisms.
gloves in the receptacle designated
by the agency.
8. Document all relevant information.
• Record the removal of the tube, the 28/2/15 1500 NG tube removed
amount and appearance of any intact without difficulty. Oral & nasal
drainage, if the tube was connected care given. No bleeding or excoriation
to suction, and relevant assessments noted. Client states is hungry &
of the client thirsty. 60 mL apple juice given. No
c/o nausea. ––––––J. BUENO, RN

________________________________
Signature over Printed Name of Student

Evaluated By:

________________________________
Signature over Printed Name
 Clinical Instructor

PAMANTASAN NG LUNGSOD NG MAYNILA

COLLEGE OF NURSING

Medical- Surgical Nursing II

SKILLS LABORATORY CHECKLIST

BUENO, Jessa Mae D

Name: ______________________________________ February 28, 2024
Date: ______________________________
3-8
Year Level and Block: _______________________ Prof. Dimasuay
Clinical Instructor: ___________________

Rating scale:

3 Performed correctly, systematically according to standard with correct rationale.

2 Performed correctly, with correct rationale but not systematic.
1 Performed correctly, but not systematic and with inadequate rationale.
0 Performed incorrectly.

Procedure: Managing Enteral Tube Feeding

PREPARATION RATIONALE PERFORMANCE REMARKS

3 2 1 0
Purpose
• Provides nutrition supplementation To restore or maintain nutritional
to clients who cannot ingest status.
adequate amounts of nutrients
orally.

Equipment:
• Stethoscope
• Ph paper (optional)
• Irrigation set with a 60 ml piston-
type syringe.
• Washcloth and towel
• Disposable gavage feeding set (bag
and tubing appropriate for pump)
• Tube feeding product (at room
temp.) ordered by doctor.
• Administration pump
• Nonsterile gloves
• Glass or cup
• pen
Assessment should focus on the following: to ensure that the patient's
• nutritional status (skin turgor, urine nutritional needs are adequately
output, weight, caloric intake, met and to identify any potential
pertinent lab values) deficiencies or imbalances that
 may affect the effectiveness of
enteral feeding.

• Gi functioning (abdominal distention,

This evaluation helps prevent
bowel sounds).
complications such as feeding
intolerance, aspiration, and
gastrointestinal discomfort.

• Elimination pattern (diarrhea, addressing these issues before

constipation, date of last bowel initiating enteral feeding, can
movement) mitigate the risk of complications
ensuring safe and effective
nutritional support.

• Response to previous enteral Understanding the patient

nutritional support. previous feedings, including any
adverse reactions or complications,
allows healthcare providers to
adjust the feeding formula, rate, or
method as necessary to prevent
recurrence of issues and ensure
patient safety and comfort.

This proactive approach minimizes

• Medical diagnoses that may affect
complications such as feeding
tolerance to product or
administration. intolerance, aspiration, or
exacerbation of underlying
medical conditions

• Doctors order for nutritional product verifying the doctor's order before
and route of delivery. enteral feeding helps ensure that the
patient receives the right nutrition in
the safest and most effective manner.

• Confirmation of tube location. Verifying the tube's correct

placement helps prevent
complications
• Residual feeding amounts.
to assess gastric emptying and
tolerance to previous feedings
• Condition of skin at site of enteral
tube insertion
Checking the skin integrity ensures
that the tube insertion site is
 healthy and free from
complications
Procedure
1. Perform hand hygiene and organize Ensures adherence to prescribed
equipment. Confirm orders for treatment plan and prevents
formula frequency, route, and rate, of errors.
feedings:
• Change disposable gavage
to maintain hygiene and prevent
feeding sets every 24 hours as
the risk of contamination and
per manufacturer’s guidelines
or agency policy. infection.

Compatible tubing ensures a

• Select tubing that is
secure connection between the
compatible with feeding bag
and pump (if used). feeding bag, pump (if used), and
the patient's enteral access device

• Determine amount of free to ensure accurate hydration and

water to be infused and pour maintain fluid balance in the
into cup. patient.

2. Explain procedure to client; provide Promotes patient understanding,

for privacy. cooperation, and reduces anxiety.

3. Adjust bed to comfortable working to optimize ergonomics and

height. enhance the safety and efficiency
of the feeding procedure.

4. Place or assist client into appropriate These positions enhance the

position. The head of the bed should gravitational flow of the solution and
be elevated in high Fowler’s position prevent aspiration of fluid into the
during and for at least 30 min after lungs
the feeding
5. Don gloves to reduce the risk of contamination
and infection

6. Assess abdomen, noting the ensures early detection of

presence of bowel sounds. Assess complications, allowing timely
skin at site as enteral tube enters intervention and providing site
body (naris or abdomen). provide site care as per doctor's orders or
care as per doctor’s orders or agency
agency policy, maintains hygiene
policy, if appropriate.
and reduces the risk of infection or
discomfort for the patient.

7. Verify tube placement Ensures safe and effective delivery

of feedings into the
gastrointestinal tract, preventing
complications like aspiration.
8. To administer a continuous tube
feeding:
• Prepare formula: Remove An excessively cold feeding may cause
formula from refrigerator 30 abdominal cramps.
mins. Before hanging (if
applicable)

• Rinse bag and tubing with removes any residual formula or

water. medication from previous
feedings, and to prevent
contamination and ensure the
delivery of clean nutrition

This process allows for controlled

• Close roller clamp on gavage
administration of the formula,
tubing and pour a 4 hour
minimizing the risk of overfeeding
volume of formula in bag.
or underfeeding and promoting
optimal absorption and utilization
of nutrients by the patient.

to ensure proper priming of the

• Open roller clamp and allow tubing and accurate delivery of the
formula to flow to end. Clamp enteral formula. Priming the
tubing and insert into pump tubing removes air bubbles and
mechanism if used. ensures that the formula reaches
the patient without interruption,
minimizing the risk of inaccurate
feeding or air embolism.

9. Attach feeding bag tubing to enteral to establish a secure and direct

tubing to enteral tube attached to pathway for delivering enteral
client. nutrition

10. Set pump to deliver appropriate setting the pump to deliver the
volume and check infusion every 1-2 prescribed volume will regulate the
hr. flow of enteral nutrition accurately
and Regularly checking the
infusion allows for ongoing
assessment of the patient's
tolerance to the feeding regimen,
facilitating prompt adjustments as
needed to prevent complications
such as feeding intolerance or
aspiration.
11. Every 4 hour:
• Stop infusion; slowly aspirate This is done to evaluate absorption of
gastric contents, taking care the last feeding; that is, whether
not to pull on tube; and note undigested formula from a previous
amount of residual feeding. feeding remains. If the tube is in the
small intestine, residual contents
cannot be aspirated.

At some agencies, a feeding is

• If residual is greater than
delayed when the specified amount
specified amount as per
or more of formula remains in the
orders (commonly 100ml)
stomach.
discard aspirated volume
from stomach, cease feedings
and notify doctors.

• If residual feeding is within Removal of the contents could disturb

acceptable level return to the client’s electrolyte balance.
stomach.

• Monitor bowel sounds in all to assess gastrointestinal motility

abdominal quadrants. and function, changes in bowel
sounds, such as the absence or
irregularity of sounds, may indicate
feeding intolerance.

Reduces the risk of oral

• Perform mouth care
complications and maintains
patient comfort.

12. Irrigate tube every 2-3 hour and Water flushes the lumen of the tube,
before and after medication preventing future blockage by sticky
administration with 30-60ml of water formula.
or as per doctor’s order or agency
policy.
13. Once each shift, while irrigating To prevents contamination and
enteral tube after completing a dose blockages, ensuring safe enteral
of formula, rinse bag and gavage feeding. This practice maintains
tubing with water. cleanliness and reduces the risk of
bacterial growth, promoting
patient safety.
 14. Restore or discard all equipment To ensures hygiene and reduces
appropriately the risk of contamination for
subsequent use

15. Remove and discard gloves and reduces the risk of cross-
perform hand hygiene contamination and minimizes the
spread of infection

Managing Intermittent Feeding

1. Follow steps 1-7 above Ensures adherence to prescribed
treatment plan and prevents
errors.

2. Check for residual. To ensures adequate gastric

emptying and reduces the risk of
complications such as aspiration or
overfeeding.

3. Crimp tube and connect syringe to Pinching or clamping the tube

enteral tube and aspirate small prevents excess air from entering the
amount of contents to fill tube and stomach and causing distention
lower portion of syringe
4. Fill syringe with formula and allow to
flow slowly into enteral tube. Infuse At this height, the formula should run
formula holding syringe 6 inches at a safe rate into the stomach or
above tube insertion site (nose and intestine.
abdomen) follow with water.
5. Do not allow syringe to empty until Clamping prevents air from entering
formula and water have completely the tube.
infused.
6. Clamp enteral tube, remove syringe, These positions facilitate digestion
and remind client to stay in semi- and movement of the feeding from
fowlers or high fowler’s position for the stomach along the alimentary
at least 30 min after the feeding. tract, and prevent the potential
aspiration of the feeding into the
lungs.

7. Check enteral tube placement and This assessment helps confirm the
residual feeding before each tube correct placement of the tube in
feeding. the gastrointestinal tract, reducing
the risk of complications

8. Restore or discard all equipment If the equipment is to be reused,

appropriately. wash it thoroughly with soap and
water so that it is ready for reuse.
 Change the equipment every 24
hours or according to agency policy.
9. Remove and discard gloves and reduces the risk of cross-
perform hand hygiene contamination and minimizes the
spread of infection

10. Evaluate and documents all relevant

information.
• Assessment of tube
placement and method of
confirmation 4.5. Pt. in Fowler’s position. 1 L room-
• Assessment site of tube entry temperature ordered formula begun
• Amount of residual feeding @ 60 mL/hour on pump. No nausea
• Amount and type of product reported. –––––––––––J. BUENO, RN
given
• Amount of water given with
and between feedings
• Route and method of delivery
• Client position during and
after administration of
products.
• Client tolerance of procedure
• Teaching performed.

________________________________
Signature over Printed Name of Student

Evaluated By:

________________________________
Signature over Printed Name
Clinical Instructor