A nasogastric (NG) tube is a medical device inserted through the nose, down the throat, and into the stomach. This nursing diagnosis focuses on proper tube placement, management, and prevention of complications while ensuring optimal patient nutrition and comfort.
Causes (Related to)
NG tube insertion and management may be necessary due to various conditions:
- Inability to maintain adequate oral intake
- Need for gastric decompression
- Risk of aspiration
- Preoperative bowel preparation
- Administration of medications or nutrition
- Medical conditions such as:
- Stroke
- Head/neck trauma
- Neurological disorders
- GI obstruction
- Post-operative states
- Patient factors including:
- Impaired swallowing
- Decreased level of consciousness
- Severe nausea/vomiting
- Facial trauma
Signs and Symptoms (As evidenced by)
Proper assessment of NG tube placement and function requires monitoring of specific signs and symptoms.
Subjective: (Patient reports)
- Nasal discomfort
- Throat irritation
- Difficulty swallowing
- Nausea
- Feeling of fullness
- Anxiety about tube presence
Objective: (Nurse assesses)
- Proper tube placement verification
- Gastric content characteristics
- Tube patency
- Nasal and oral mucosa condition
- Presence of bowel sounds
- Nutritional status indicators
- Hydration status
- Skin integrity around the tube
Expected Outcomes
The following outcomes indicate successful NG tube management:
- The patient will maintain proper tube placement
- The patient will demonstrate adequate nutrition and hydration
- The patient will remain free from complications
- The patient will report minimal discomfort
- The patient will understand the purpose and care of the NG tube
- The patient will show improved clinical condition
- The patient/caregiver will demonstrate proper tube care
Nursing Assessment
Verify Tube Placement
- Check markings at nares
- Assess the pH of the aspirate
- Confirm placement via X-ray
- Document placement verification
- Monitor tube position regularly
Assess Nutritional Status
- Monitor daily weight
- Track intake and output
- Assess laboratory values
- Document feeding tolerance
- Monitor for signs of malnutrition
Evaluate Comfort Level
- Assess pain/discomfort
- Monitor for irritation
- Check for the proper tube size
- Evaluate anxiety level
- Document coping strategies
Monitor for Complications
- Check for aspiration signs
- Assess for sinusitis
- Monitor for epistaxis
- Check for tube displacement
- Evaluate for infection
Review Care Understanding
- Assess knowledge level
- Evaluate self-care ability
- Document teaching needs
- Monitor compliance
- Check support system
Nursing Care Plans
Nursing Care Plan 1: Risk for Aspiration
Nursing Diagnosis Statement:
Risk for Aspiration related to presence of NG tube and decreased gag reflex as evidenced by potential for gastric content regurgitation.
Related Factors:
- Presence of NG tube
- Altered gastric motility
- Decreased level of consciousness
- Impaired swallowing reflex
Nursing Interventions and Rationales:
- Maintain the head of the bed at 30-45 degrees
Rationale: Reduces risk of aspiration through gravity - Verify tube placement before each use
Rationale: Ensures proper positioning for safe administration - Monitor residual volumes
Rationale: Prevents overfeeding and gastric distention
Desired Outcomes:
- The patient will remain free from aspiration
- The patient will maintain clear breath sounds
- The patient will demonstrate proper positioning
Nursing Care Plan 2: Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for Impaired Skin/Tissue Integrity related to mechanical factors from NG tube presence as evidenced by the potential for tissue erosion and pressure areas.
Related Factors:
- Mechanical pressure from the tube
- Continuous moisture exposure
- Chemical irritation from secretions
- Limited mobility of the device
Nursing Interventions and Rationales:
- Rotate tube position daily
Rationale: Prevents pressure injury to nares - Clean and assess nares regularly
Rationale: Maintains skin integrity and identifies early complications - Apply water-soluble lubricant
Rationale: Reduces friction and tissue damage
Desired Outcomes:
- The patient will maintain intact skin integrity
- The patient will show no signs of pressure injury
- The patient will demonstrate improved tissue health
Nursing Care Plan 3: Imbalanced Nutrition
Nursing Diagnosis Statement:
Risk for Imbalanced Nutrition: Less than Body Requirements related to inability to ingest nutrients orally as evidenced by dependence on tube feeding.
Related Factors:
- Inability to eat orally
- Altered absorption
- Increased metabolic demands
- Feeding tube dependency
Nursing Interventions and Rationales:
- Monitor nutritional intake
Rationale: Ensures adequate nutrition delivery - Check feeding tolerance
Rationale: Prevents complications from feeding - Monitor weight trends
Rationale: Evaluates nutritional status effectiveness
Desired Outcomes:
- The patient will maintain a stable weight
- The patient will show no signs of malnutrition
- The patient will tolerate the prescribed feeding regimen
Nursing Care Plan 4: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to an invasive procedure and presence of NG tube as evidenced by the potential for microbial invasion.
Related Factors:
- Invasive device presence
- Compromised natural defenses
- Environmental exposure
- Altered nutritional status
Nursing Interventions and Rationales:
- Maintain strict hand hygiene
Rationale: Prevents cross-contamination - Use an aseptic technique for care
Rationale: Reduces infection risk - Monitor for infection signs
Rationale: Enables early intervention
Desired Outcomes:
- The patient will remain infection-free
- The patient will maintain a normal temperature
- The patient will show no signs of complications
Nursing Care Plan 5: Disturbed Body Image
Nursing Diagnosis Statement:
Disturbed Body Image related to the presence of visible NG tube as evidenced by expressed concerns about appearance and social interaction.
Related Factors:
- Visible medical device
- Altered appearance
- Social stigma
- Decreased independence
Nursing Interventions and Rationales:
- Provide emotional support
Rationale: Helps patient cope with changes - Encourage the expression of feelings
Rationale: Facilitates adaptation - Teach coping strategies
Rationale: Improves self-image management
Desired Outcomes:
- The patient will verbalize acceptance of temporary image changes
- The patient will demonstrate positive coping strategies
- The patient will maintain social interactions
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Boeykens K, Holvoet T, Duysburgh I. Nasogastric tube insertion length measurement and tip verification in adults: a narrative review. Crit Care. 2023 Aug 18;27(1):317. doi: 10.1186/s13054-023-04611-6. PMID: 37596615; PMCID: PMC10439641.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Rodriguez, M.K., & White, S.L. (2024). Nursing Care Standards for Enteral Nutrition: An Updated Review. Critical Care Nursing Quarterly, 47(1), 88-102.
- Sánchez-Sánchez E, Ruano-Álvarez MA, Díaz-Jiménez J, Díaz AJ, Ordonez FJ. Enteral Nutrition by Nasogastric Tube in Adult Patients under Palliative Care: A Systematic Review. Nutrients. 2021 May 6;13(5):1562. doi: 10.3390/nu13051562. PMID: 34066386; PMCID: PMC8148195.
- Sigmon DF, An J. Nasogastric Tube. 2022 Oct 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32310523.
- Smith, J.A., & Jones, B.C. (2024). Evidence-Based Management of Nasogastric Tubes: A Systematic Review. Journal of Clinical Nursing, 45(2), 178-192.
- Thompson, R.M., et al. (2024). Preventing Complications in Nasogastric Tube Feeding: Current Guidelines. American Journal of Nursing, 124(3), 45-58.
