Question

Your client had a gastrostomy tube insertion.   What is the most certain way to insure proper placement?

You have just begun your shift at 7am and Mr. Fitbit has a NTP (Nitropaste) patch applied to his chest at 5am. You are taking his vital signs, and you notice that the BP is 80/ 50. What is your first action? What is your next action?

Mr. Vincent receives eye drops to both eyes at bedtime (HS). What is the correct method of applying eye drops? What is the correct term for “drops”?

Answer 1

1.WAYS TO ENSURE PROPER PLACEMENT OF GASTROSTOMY TUBE

Two methods can be used.

a) Aspiration method :Connect an extension set to the G tube and a syringe with 10 mL water to the extension set feeding port. Pull back on the plunger to see the stomach contents in the tube, then flush with the water in the syringe. Stomach contents are usually yellow or clear.

b)Auscultation method : Draw 5 - 10 mL of air into the syringe and attach the syringe to the extension attached to the G tube. Using a stethoscope , listen over the left side of abdomen above the waist . When you inject the air, you should hear a growl or rumbling or bubbling sound as the air goes in.

These two methods confirm the position of G tube.

2.FIRST ACTION

Remove the NTP PATCH applied to his chest. Hypotension is due to nitroglycerin overdose.

SECOND ACTION

Hypotension associated with nitroglycerin overdose is the result of venodialation and arterial hypovolemia, the first steps are initiated to increase central fluid volume. No specific antagonist are there for vasodilator effects of NTG.

Inform the physician on duty.Position the patient in shock position(lying flat on their back with the legs elevated upto 8 - 12 inches) and comfortably warm.Secure peripheral IV acess. Intravenous infusion of normal saline or similar fluids are necessary.Administer oxygen and artificial ventilation ,if necessary.

3.A.Procedure for eye drop instillation

a) Check patient's name and physician's order

b) Wash hands prior to instilling medication

c) Cleanse the eyelids and lashes with cotton / gauze moistened in normal saline.

d) Use each cotton ball for one stroke only, by moving from inner to outer canthus of eye.

e) Tilt the patient's head slightly if he is sitting or place head over a pillow if he is lying down.

f)Fill the eye dropper with medication .

g)Using fore finger, pull lower lid down gently and instruct the patient to look upward.

h) Hold the drop close to eye, allow the prescribed drops to fall in the lower conjunctival sac, not on cornea.

i) Release the lower lid after drops are instilled. instruct the patient to close eyes slowly, move the eye, and not to squeeze or rub,

j)Wipe off excess solution on cheeks using cotton / gauze

k)Wash hands after the procedure.

B) Correct medical term for drops is instillation. The procedure is occular instillation.