JOSE RIZAL UNIVERSITY
College of Nursing and Health Sciences
                                                    Performance Checklist
                                      Administering Enteral Feeding via Nasogastric Tube
     Name of Student: _Nika Eunice Mojar___                             Date: _03/29/22__________
     Year/Section/Group No.: _2nd 202N_/Grp 2__                         Grade: __________
                                        Rate the student’s performance by checking the appropriate box using the following criteria:
                                        5- Excellent             (Carries out procedure efficiently, systematically and
                                        independently/ Personality trait is observed at all times)
                                        4- Very Satisfactory (Carries out procedure efficiently and systematically, requires
                                        minimal guidance and supervision/
                                                                    Personality trait is observed most of the time)
                                        3- Satisfactory         (Carries out procedure efficiently and systematically, requires
                                        moderate guidance and supervision/
                                                                    Personality trait is observed sometimes)
                                        2- Fair                   (Carries out procedure with close guidance and supervision/
                                        Personality trait is seldom observed)
                                        1- Poor                   (Carries out procedure inefficiently and unsystematically/
                                        Personality trait is never observed)
    Procedures                                              Rationale
A. KNOWLEDGE
1 Check physician’s order        for type, amount           Check appropriate orders relevant to patient safety.
. and time of feedings.
2   Wash your hands                                         To prevent transmission of microorganism present in
.                                                           your hand.
3  Assemble equipment.                                      To save time and effort
.     a. Prescribed feeding solution
      b. 10-20 ml for infant and 5-10 ml for
          neonate)
      c. Glass with calibration
      d. 10-20 ml. water
      e. Small towel
      f. Stethoscope
B. SKILLS
4 Identify the patient.                                     Patient identification mistakes can lead to errors in
.                                                           procedures being perform on a wrong patient
5 Bring the equipment to the bedside and                    For easy access to all the materials.
. explain the procedure to the client.
6 Inspect and palpates patients’ abdomen for                Document assessment findings and determine
. distention.                                               appropriateness of NG tube insertion related to reason
                                                            for insertion and patient’s physical assessment.
7   Place the patient in high fowlers’ position             This allows the NG tube to pass more easily through the
.                                                           nasopharynx and into the stomach.
8 Spread the small towel across the clients’      Nasal and oral secretions may be evident during the
. chest                                           procedure.
9 Attach the syringe at the tip of the NGT.
.
1 Check placement of the nasogastric tube         Before putting some liquid you need to check the NGT if
0 using the two techniques.                       it is in a proper place.
.
      a. Aspiration of gastric contents to
           stomach through syringe using
           gravity.
      b. Auscultation – inject 1-5 ml (for        B. Sound generated by air blown through the tube is
           infant) and 1-2ml (for neonate) of     used to determine tube placement in the gastrointestinal
           air while listening with stethoscope   tract.
           positioned at the epigastric area,
           listened for a whooshing or
           gurgling sound.
1 Initiate intermittent feeding, pinch            This keeps fluid from coming back out.
1 proximal end of the feeding tube.
.
1 Fill the syringe with formula and keep the      The higher of the syringe controls how quickly the
2 bottom of the syringe no higher than 6          formula is given.
.
  inches above the child's stomach.
1 Release tubing and allow formula to flow        To start the feeding
3 in by gravity.
.
1 After administering the prescribed amount       To prevent the tube from becoming clogged.
4 of formula, flush tubing with at least 5-20
.
  ml of water (depending on the viscosity of
  the feed / medication).
1 After feeding is completed, cover end of        This allows air to get into his stomach and can cause
5 the feeding tube with plug or clamp.            discomfort.
.
1 Burp the child and have child's head raised     Burping allows your baby to remove some of that
6 for about 30 minutes after the feeding is       gassiness to relieve the pain.
.
  done.
1 Rinse equipment with warm water and dry         It will be ready for the next time you will use it again.
7
.
1 Record / document the procedure and             For references.
8 include:
.
      a. Type and amount of feeding given
      b. Time it was given
      c. Amount of additional water given
      d. Patients’ tolerance of procedure
1 Monitor breath sounds, bowel sounds,            Timely and accurate documentation promotes patient
9 gastric distention, diarrhea, constipation,     safety.
.
  intake and output, daily weight and serum
  chemistry results.
    TOTAL
Total score / Total no of items x 60 + 40 = _____
Total Grade _________
Clinical Instructor’s Comments / Suggestions:
______________________________________________________________________________________________________
____________________________________________________.
Students’ Comments / Suggestions:
______________________________________________________________________________________________________
_____________________________________________________.
________________________________                    _________________________
Student’s name & signature                            C.I.’s name & signature