Head Injury that needed an Intubation and extubate (Nasogastric Tube – Risk Associated

The paper focuses on the patient, Mr. Borg, a construction worker who a head injury that needed an intubation and extube got feeding, as a case which is to be evaluated. The discussion encompasses the picking, placing, and confirming of a nasogastric tube with an oral end as well that also covers the kinds of feed and rate of the feed and the monitoring of absorption, policies and, documentation. It also studies the risks and benefits of putting in a percutaneous endoscopic gastroscopy tube for the long-term nutritive supply by this route. Through these connection with Mrs. Borg she even feel pleasant surprise through confirmed about Mr. Borg treatment and care giving system. The paper stresses the rules where labelled and protocols referred to as well as the use of documentation methods that safeguard the patient care.

Task 2: Individual Write-up

1-   Discussion & Debate in your own words

a)    Which type / size of nasogastric tube would you insert and why

Identifying the appropriate NG tube for Mr. Borg’s case should be aided by the tube’s usage targets such as (feeding), its suitability to the patient’s anatomy, and effects caused by the tube on the patient. A French (Fr) NG tube size for an adult is usually between 12-14 units in diameter. Mr. Borg is recommended to have a 12 French tube because this – size would be large enough for the tube to be effective in delivering nutrients and medicines, yet small enough to create less discomfort and less chance for nasal injury. The silicone or polyurethane hoses is better option than the PVC because of their flexibility and monotonous irritation rate.

b)    How you would insert the nasogastric tube

The procedure of feeding tube insertion follows the safety and comfort procedures, which are also recommended by protocols such as those of the National Institute for Health and Care Excellence (NICE). Before starting, it is important to explain the procedure to Mr. Borg (if conscious) to reduce his stress and assemble all required instruments, including the NG tube, water-soluble lubricant, a glass containing a straw, a syringe, and pH indicator strips. Mr Borg have to be positioned at a semi-upright angle (45-degree) in order to ease the passage of the tube and lessen the risk of aspiration. The length of tube to be inserted should be measured from the nose tip to the earlobe and then to the xiphoid process (the lower part of the sternum) and marked on the tube with a piece of tape or a marker. Lubricating the initial 5-10 cm of the tube eased insertion and lowered risk of nasal injury. Carefully, put the tube into the nostril, subsequently turn it backwards and then downwards along the nasal floor. In case Mr. Borg is conscious, ask him to swallow water using a straw as you advance the tube down the esophagus. This movement creates a pathway into the esophagus. If he is unconscious, introduce the tube so that it coincides with the breathing processes. When the tube has been advanced to the marked length, it should be applied to the nose using tape, not too tight so as to prevent pressure sores.

c)     How you would confirm the position of the nasogastric tube

The position of the NG tube (nasogastric tube) is quite important in the process to prevent aspiration pneumonia, which is one of the unwanted complications. The initial step units on withdrawing gastric fluids by tube syringe appended over the supporting tubing; these blow-up fluids into the disposal bed by instilling slight amount of gastric content inside the syringe. This could be performed by the dissection near the classroom and then testing it using pH indicator strips. pH 1-5 (gastric position) would have been the likely result but a pH 5 could also be received as this may be due to the buffering solutions that have been used to adjust the acidity of the stomach. The tube is located by X-ray in a real-time setting and regulations get updated which leads to the gold standard even in the ICU. The probe needs to be fixed so that it looks like the tube is closing the stomach without entering the respiratory system. This serves to prevent deviations from the target and thus includes everything, without any trouble appearing.

d)    At What rate would you start the feed and why (using Protocols / not ICU protocols)

Starting at a lower rate is vital to avoid such ills as refeeding syndrome and other complications, which may arise after introducing enteral feeding. For Mr. Borg, a dose of 20-30 ml/hour would be considered the entry level. The rate creates adaptation environment in his gastrointestinal tract to fully accept the feed. During the 24-48 hour period if Mr. Borg does not become intolerant of the medicine then symptoms worsen, we should put them in the intensive care unit. g. (This can be associated with nausea, vomiting, abdominal distention as well restless legs, apnea [Oropharyngeal aspiration]), the feeding rate can be gradually increased by 10-20 ml/hour every 4-6 hours until the target rate is achieved according to ward protocols. The slow start is very important as it avoids metabolic problems which may develop especially in the patients who are malnourished or had fasted for a while.

e)     Tell me more about the type of feed started and why that feed was started

A polymeric feed would most likely be selected for Mr. Borg’s pupil, which comprises whole proteins, carbohydrates and fats. These balanced formulas are complete in nutrients and are sufficiently well-balanced for an extended-term use. Bonusicka, Jevity or Osmolite are illustrations. Positioning consumers in every step of the way to their wellbeing, what particular option entails will be based on Mr. Borg’s nutrition status, what food he can tolerate and his existing condition. Polymers feeds are mostly tolerated and imamate the regular intake, supplying the whole range of nutrients these patients need. This especially relates to the care for Mr. Borg who is currently in acute stage and thus critically needs adequate protein intake for the wound to heal and the proper muscle maintenance.

f)      Checking the absorption

The process of absorption in MR. Borg is crucial to avoid the possibility of deficiency in his nutritional intake. This is achieved by the constant GRV test (for high residuals) being done every four to six hours as they are those greater or more than 200-250 ml, which may show poor gastric emptying and a high possibility of aspiration. If excess of gastric retained volume is diagnosed, the infusion rate will obviously have to be decreased and the formulation of a promotility drug (‘prokinetic’ drug) can be used. Also, besides the laboratory tests to determine treat fed intolerance which can be nausea, vomiting, abdominal distention or diarrhea, the process is vital. The symptom could essentially mean that one is not properly absorbing enough nutrients or has gastrointestinal problem(s). The practical methods which might be employed should also be based on the regular blood tests, for example, blood sugar measurements, electrolyte panels and others. Such tests would make it possible to keep the body stable and nutrition levels adequate. Changes in the feeding regimen will likely be necessary to bring about the dreamed effects.

g)    Policies / Protocols in place

He or she is accountable for patients under his care and safety applying the institution’s standards and regulations. Typically, these protocols enlist the specific step-by-step steps to sew in the NG tubes, to ascertain accuracy of location and how to handle the most common difficulties. Enteral feeding protocols which are a part of process that starts, progress and monitor the feed intolerance are a part of the process too as they guide and manage complications. Specific recommendations on assessing time to time the right location of the tube as well as Gastro Intestinal Resistance Volume (GRV), clinical presentation of intolerance and the blood markers linked with the condition is proportioned in the monitoring and assessment protocols. The modes of emergency are a path to be followed if any of the difficulties like the displacement of the tube or aspiration, or the metabolic disorders occur. Nonstop our team communicates and applies protocols with professionals also mentors in the field to ensure a steady supply of high quality treatment.

2-   Discuss and debate the following:

a)    Risks associated with the procedure

A complication with the highest chance of resulting in death could be the infection that arises out of the Peptic extension gut element (PEG) tube insertion. The drawback will be; the patients with weak immune or prone to infections in case they are in a dirty state that makes this insertion route be an unsecure one. The other severe risk is superior gastrointestinal tract perforation. This is one of the chances but worst cases result in literary critical outcomes. Moreover, they have damaged the intestines which are internally looped; peritonitis, is an agonizing condition that has proved to be pretty worrisome. The PEG tube feeding can also pose asthghraphic concerns, as aspiration risk is its major concern due to which it is a significant safety issue.

b)    Benefits of the procedure

Stable nutrition via PEG tube feeding is a way to ensure the digestive needs of patients like Mr. Borg get met, at a time when they have an oral impossibility to do so, due to digestive conditions or any other health factors causing them the inability to “eat by mouth”. This normalizes parenteral nutrition, the major way of his nutritional intake, and curve and the nutritional status of Mr. Borg’s remains crucial for his recovery process. Also a PEG tube decreases the risk of aspiration through the process of avoiding the oral and pharyngeal stage of swallowing by bypassing, which make it much better about the oral feed.

c)     Care of the PEG

The importance of the care and the maintenance of the PEG site cannot be underestimated as they ensure that no cases of transmissions of infections occur. Sealing the PEG tube with tape is the key to avoid dislodgment of the tube and should always be the first step as any time you roll out the dressings or change clothes. These patients should be prepped according to the doctor’s order and we should be mindful of things such as vomit or choking. The PEEPs supervision and the patience’s reaction to eating it is an integral part. If symptoms of inflammation, leakage, or pain are observed, the team must notify the medical support and treatment procedures will be immediately implemented.

d)    Why do a PEG tube over other ways of feeding.

It would be very beneficial to implant PEG tubes close to proximal intestinal parts upon Mr. Borg’s revival. Nasogastric tubes proved to be more proper for the patients who have a weak coughing rather than PEG tubes. PEG tube comes with the advantage of no nasal discomfort because the nasogastric tube has been no longer needed. PEG tubes are easy to use because once they are in secure place you will have broad spectrum of feeding procedure that are more comfortable than others and require less maintenance as well.

3-   Conversation with Mrs Borg

Mrs. Borg: Hello, my husband how are you feeling? Is his treatment satisfactory?

You: Hello, Mrs. Borg. I’m glad you’re here. Mr. Borg is in the stable state, and the doctors are keeping a close watch on his improvement. It’s our team doing the best for him.

Mrs. Borg: Thank you for the update. How does he react to the tube feeding?

You: He’s getting on well with the feeding tube. Our endeavour is that he recovers well and properly nourished.

Mrs. Borg: What impact will the feeding tube have on his routine for the day?

You: His daily routine won’t get affected much as he will get used to it. We will teach him how to do tube feedings and tube care.

Mrs. Borg: Can he manage with simple home-health procedures after discharge?

You: We, therefore, will give you specific recommendations on how to pamper the dude when he is discharged. For instance, he might help with feeding tube management since this is important, as well as tracking his progress.

Mrs. Borg: Is the doctor going to advise any in-patient therapy after discharge?

You: We shall discuss the need for any in-patient follow-up care plus, the procedure of discharge planning. This will be arranging of such services as the doctor visits of his care-giving team or other specialists that can ensure his continuing of improvement.

Mrs. Borg: What could be my strategy of repatriation from his trip?

You: We will give you a step-by-step guideline that will show you how to keep him at home. This can include anything from his tube transition to feeding, being informed about monitoring his progress, and being able to spot signs of complications.

Mrs. Borg: I’m concerned about how I’m off the mark to look after him.

You: We’ll make sure you get all the info and help to have this right deicing and caring for him after discharging him from the hospital. Good you consider his caretaking supposition.

Conclusion

Therefore, Mr. Borg’s case can be considered an exemplar of an acute patient care approach has to be made in extreme situations. Correct nasogastric tube placement and insertion remains a vital step that should be made to ensure safety during enteral feeding. The implementation of procedures and standards, and the maintenance of complete records, is a provision that will guarantee the maintenance of the high quality of the care being offered. Careful scrutiny of long-term enteral feeding choices, involving a PEG tube or any other alimentary route, takes into consideration the risks and benefits. The dialogue with her family, as in the encounter with Mrs. Borg, is one of the main determinants of providing patients with needed security and care. Moreover, this case is an underlay of the comprehensive approach to patient care that places safety, communication, and adherence to standards as the cornerstone.