🛏️ Basic Care & Comfort · Lesson 2 of 6 · 7 min

NG Tubes, Enteral Feeds and Keeping Food Out of Lungs

🫗 The feeding pump is running. The client is lying flat because 'the family wanted him comfortable'. The nurse hears gurgling. Every rule for tube feeding exists because of this scene.

💡 Key idea

X-ray confirms placement; pH 5 or lower supports it. Head of bed 30 to 45 degrees, flush 30 mL around meds, one drug at a time, never crush extended-release.

🧠 Why it matters

Confirm NASOGASTRIC tube placement by X-RAY before the first use; this is the gold standard. At the bedside, check gastric pH (5 or lower suggests the stomach) and mark the tube at the nares; auscultating injected air is unreliable and should not be used to check placement. For ASPIRATION PRECAUTIONS, keep the head of the bed at 30 to 45 degrees during feeding and for 30 to 60 minutes after, check gastric residual per policy and hold or report high volumes with distention, nausea or vomiting, and flush with 30 mL of water before and after medications and feedings. Give medications one at a time, crush only immediate-release tablets, and never crush enteric-coated or extended-release products. For dysphagia after a stroke, keep the client upright, use a chin-tuck swallow, offer thickened liquids as ordered, avoid thin liquids and straws, and keep suction available. Coughing with meals, a wet or gurgling voice, and pocketing food are warning signs; stop and report.

🏥 In the real world

💊 A nurse crushes a client's extended-release metoprolol into a feeding tube to save time. The whole 24-hour dose hits at once; the client becomes bradycardic and hypotensive. The pharmacist converts the order to an immediate-release form given in divided doses. 'XL', 'ER', 'SR' and 'EC' on a label are the exam's way of saying 'do not crush'.

📌 Takeaways

X-ray before first use; pH ≤ 5 and nares marking at the bedside
HOB 30 to 45 degrees during and after feeds; flush 30 mL before and after meds
Never crush enteric-coated or extended-release medications

✅ Test yourself

Which method is the most reliable for confirming initial placement of a newly inserted nasogastric tube?

Abdominal X-ray
Injecting air and auscultating over the stomach
Checking the pH of aspirate
Observing the client swallow

Answer: A · Abdominal X-ray

Radiographic confirmation is the gold standard before the first use. pH checking is a bedside supplement for ongoing checks.

A client receiving continuous tube feeding must be repositioned. What is the correct head-of-bed position during and after the feeding?

Any position is acceptable if the pump is running
Flat
Trendelenburg
At least 30 to 45 degrees

Answer: D · At least 30 to 45 degrees

Elevating the head of the bed reduces reflux and aspiration during and after enteral feeding.

A client with dysphagia after a stroke coughs and has a gurgling voice while drinking water. What should the nurse do?

Offer thin liquids only
Encourage the client to drink faster through a straw
Stop oral intake and request a swallow evaluation
Lie the client flat to rest

Answer: C · Stop oral intake and request a swallow evaluation

Coughing and a wet voice indicate aspiration. Stop, protect the airway and obtain a speech-language pathology evaluation.

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