St.

Paul University Manila

(St. Paul University System)
680 Pedro Gil St., Malate, 1004 Manila, Philippines

College of Nursing and Allied Health Sciences

SKILL TITLE: Insertion of Naso-gastric Tube

NAME : _______________________________________________ SCORE: ____________

YEAR LEVEL/SECTION: _____________ DATE: ___________________

KAR: MANAGEMENT OF RESOURCES and ENVIRONMENT

JCI 1st 2nd 4th

3rd
Raw and
Competencies Standards Performance Criteria Remarks
Score 100 90 above
/ IPSG 80%
% % 70%

 Identifies tasks COP 1. Validates chart for doctor’s order and client’s 4
or activities that written consent.
need to be MCI
accomplished
(2.1.1)
 Adheres to PCI 2. Assess patient for any history of: 4
policies, - Nasal surgery
procedures and IPSG 5 - Unusual nosebleed
protocols on - Sinusitis
prevention and (Reduce - Basal skull fracture and severe mid-face
control of the Risk of trauma
infection (2.4.2)
Health 3. Performs hand washing before wearing clean 3
Care– gloves
Associated
Infection)

 Ensures proper COP 4. Prepares the following supplies on a tray. 4

functioning of Checks for flaws and expiration date.
equipment (2.3) - Naso-gastric tube (suitable size for adults fr 14-18)
- Water Soluble lubricant
- Emesis basin
- Gauze
- Asepto syringe
- Protective sheet
- Adhesive tape
- Scissor
- Glass of water
- Tissue paper

KAR: SAFE and QUALITY NURSING CARE

 Explains PFR 5. Once inside the client’s room, greets the client 3
interventions to and introduces self and colleague nurse. Places
clients and COP materials and supplies in accessible area at bedside.
family before Explains procedure and seeks consent.
carrying them
out to achieve
identified
outcomes
(1.7.3.1)

KAR: SAFE and QUALITY NURSING CARE

JCI 1st 2nd 4th

3rd
Raw and
Competencies Standards Performance Criteria Remarks
Score 100 90 above
/ IPSG 80%
% % 70%

 Obtains COP 6. Stands at the bedside. Verifies client identity 2

comprehensive using 2 patient identifiers. Explain the procedure.
client IPSG 1
information
(1.7.1.4)
 Acts to (Identify 7.
improve clients’ Patients
health condition Correctly)
or human
response
(1.7.3.3)

 Performs
nursing
activities PCI 7. Check patency of nostrils 3
effectively and
in a timely IPSG 5 8. Perform Hand hygiene 3
manner
(1.7.3.4) 9. Prepare the environment / ensure privacy: 2
Close the curtains
Adjust bed to your working height & lower side rails

 Monitors AOP 10. Position client in semi-fowler’s position. Cover 4

effectiveness of the patient’s chest. (Stand on client’s right if right
nursing COP handed and left side if left handed)
interventions 11. Perform hand hygiene and put on clean gloves 3
(1.7.4.1)
12. Using the NG tube, measure the distance 4
from the tip of the nose to the earlobe and down
the xiphoid process of the sternum. (If the naso-
 Performs gastric tube is too pliable, place the tube in emesis
nursing basin and cover with ice)
activities 13. Mark the length of the tube to be inserted
effectively and 3
with a piece of tape.
in a timely
manner 14. Lubricate the first 4 inches of the tube with
(1.7.3.4) water soluble lubricant.
15. Instruct the patient to slightly flex the neck 3
backwards. Gently insert the tube into the nare with
the end pointing downward.
16. Continue to pass tube along the floor of nasal
4
passage aiming down toward the ear. Instruct the
patient to swallow as the tube slowly advanced into
the tract while rotating the tube.
17. Instruct the patient to tip head forward once 4
the tube reaches the nasopharynx and to try to
swallow, if the client is allowed with fluids allow to
drink and advance the tube each time the client
swallow. 4
18. If resistance is met or client begins to cough,
gag or choke, withdraw the tube, re-lubricate the
tube and insert into the other nare.
19. Observe patient’s condition for signs of
respiratory distress. 4
20. Advance the tube until tape mark is reached.

KAR: SAFE and QUALITY NURSING CARE

Raw 1st 4th

JCI 2nd 3rd
Score and
Competencies Standards Performance Criteria Remarks
100 above
/ IPSG 90% 80%
% 70%

 Implements COP CHECKING OF TUBE PLACEMENT 3

nursing 21. Ask the client to talk
intervention IPSG 6 22. Check posterior pharynx for presence of coiled tube 2
that is safe and
comfortable 23. Attach asepto syringe to the end of nasogastric
(1.7.3.2) tube. Place diaphragm of stethoscope over the left
quadrant of the abdomen just below the coastal 4
margin. Inject 10-20 cc of air while ausculating the
abdomen. 4
24. Aspirate gently back to obtain gastric contents.

4
25. If tube is not in the stomach, advance another
 2.5-5 cm (1-2 in) and re-check the position.

26. Measure the exposed length of NGT to the distal 3

end. Remove gloves and requisites.
27. After the tube is properly inserted, tape the 3
nasogastric tube to the client’s nose:
- Cut 10 cm (4 in) long tape
- Split the bottom 2 in of tape in half
lengthwise
- Place the top end of the tape over the nose
and carefully wrap the two split end around
the tube.

 Analyzes the PFR 28. Informs client that the procedure is finished and 2
needs of clients addresses related concerns.
(1.4.2)
29. Environment and safety:
- Assist the patient in comfortable position 3
- Pull side rails up
- Place call bell within reach
- Unless physician orders otherwise, the head
of bed should be elevated at 30 degrees.

 Acts to PCI 30. Disposes of soiled supplies appropriately and 2

improve clients’ washes hands.
health condition IPSG 5
or human
response
(1.7.3.3)

KAR: LEGAL RESPONSIBILITY

1st 2nd 4th

JCI 3rd
Raw and
Competencies Standards Performance Criteria Remarks
Score 100 90 above
/ IPSG 80%
% % 70%

 Documents COP 31. Records the date and time procedure was done. 4
care rendered Includes assessment, type and size of NGT, which
to clients (4.3) AOP side of nostril is inserted and the exposed length of
NGT. Includes initials and/or signature.

TOTAL = 31 items

100

NB:

JCI - Joint Commission International

IPSG- International Patient Safety Goal
PFR – Patient and Family Rights
PCI – Prevention and Control of Infection
AOP – Assessment of Patients
COP – Care of Patients
MCI - Management of Communication and Information

________________________________________ ________________________________________

Signature over printed name of Signature over printed name of

STUDENT FACULTY
 Performance Checklist

FEEDING THROUGH NGT

Name: ___________________________________ Date:_____________

Performance Checklist 100% 90% 80% Remarks

1. Checks doctor’s order for feeding through
tube
2. Computes for the prescribed amount of
feeding. Prepares correct amount
3. Prepares the feeding and the medications to
be given through the tube (if any)
4. Does hand washing. Keeps area, materials
clean
5. Explains the procedure to patient. Puts
patient in high fowler’s position
6. Checks the correct placement and patency
of the tube
7. Aspirates the gastric contents and follows
institution policy regarding gastric aspirate
8. Introduces feeding at the height of 18-24
inches from point of insertion
9. Flushes the tube with 30-60 ml of water
10. Clamps the tube and instructs the patient
and/or relatives that patient should be in
high fowler’s position for at least 30
minutes after feeding.
11. Document the time & amount of feeding to
include any abnormalities.

__________________________

Clinical Instructor’s Signature

 St Paul University Manila
(St Paul University System)

College of Nursing and Allied Health Sciences

SKILL TITLE: Changing of Colostomy Bag

NAME : _______________________________________________ SCORE: ____________

YEAR LEVEL/SECTION: _____________ DATE: ___________________

KAR: MANAGEMENT OF RESOURCES and ENVIRONMENT

JCI 1st 2nd 3rd 4th

Raw and
Competencies Standards Performance Criteria Remarks
Score 100 90 80 above
/ IPSG % % % 70%

 Identifies tasks COP 1. Validates chart for doctor’s order and client’s written 4
or activities that consent.
need to be MCI
accomplished
(2.1.1)
 Adheres to PCI 2. Perform hand hygiene 4
policies,
procedures and IPSG 5
protocols on
prevention and
control of (Reduce
infection (2.4.2) the Risk of
Health 3. Assess patient’s understanding about the procedure. 3
Care– Encourage question.
Associate
d
Infection)

 Ensures proper COP 4. Prepares the following supplies on a tray. Checks for 4
functioning of flaws and expiration date.
equipment (2.3) - Non-sterile gloves 2 pairs
- Scissors
- Pencil or pen
- Towels (3 )
- Ostomy skin barriers and drainage bag
- Gauze pad
- Protective sheet
- Plastic bag

KAR: SAFE and QUALITY NURSING CARE

 Explains PFR 5. Once inside the client’s room, greets the client and 3
interventions to introduces self and colleague nurse. Verifies client
clients and COP identity using 2 patient identifiers.
family before
6. Places materials and supplies in accessible area at
carrying them
out to achieve
bedside. Explains procedure and seeks consent. 4
identified
outcomes
(1.7.3.1)
 Obtains
comprehensive
client
information
(1.7.1.4)
 Acts to COP 7. Inspect stoma and surrounding skin and perform hand 3
improve clients’ hygiene
health condition
or human
8. Prepare the environment / ensure privacy:
response
(1.7.3.3)
Close the curtains 4
10. Adjust bed to your working height & lower side rails

 Monitors AOP 9. Position client in semi-fowler’s or lying position. Cover 4

effectiveness of the patient’s abdomen surrounding the stoma. (Stand
nursing COP on client’s right if right handed and left side if left
interventions
handed)
(1.7.4.1)
10. Preform hand hygiene. Don gloves and places a 4
protective sheet (prior to the change of the colostomy
bag).

 Performs
nursing
activities
 effectively and 4
in a timely
11. Empty the drainage from the current ostomy
manner
(1.7.3.4) appliance into a clean plastic bag. REMEMBER to
measure the output.
12. Remove the soiled appliance by gently peeling it away 4
from the skin (from the top) while supporting
surrounding skin with the other hand. Dispose of the
appliance in an appropriate waste container.
13. Remove gloves and perform hand hygiene. 4

14. Don clean gloves and wipe the stoma and surrounding 4
with warm water. Pat dry with clean dry towel.

15. Measure the stoma using a measuring guide for 4

appropriate circumference.
16. Place a gauze pad over the orifice of the stoma before 4
preparing the clean appliance
17. Trace the pattern with a pencil or pen. Cut out the 4
circle in the adhesive and peel off the backing from the
adhesive seal.
18. Place the opening of the pouch over the stoma and 4
apply it directly onto the skin barrier.
19. Gently press the adhesive backing onto the skin (at 4
least 30 sec) and smooth out any wrinkles, working
from stoma outside.

20. Remove the air from the pouch and place a deodorant 3
in the pouch (optional)
21. Close the pouch by turning up the bottom a few times, 4
fanfolding its end lengthwise and securing it with
rubber band or tail closure clamp
22. Check that the pouch and closure are secured 3

 Analyzes the PFR 23. Informs client that the procedure is finished and 2
needs of addresses related concerns.
clients (1.4.2) 2
24. Peristomal skin integrity remains intact.
3
25. Assess client’s response to the procedure
26. Environment and safety:
a. Assist the patient in comfortable position
b. Pull side rails up 4
c. Place call bell within reach
d. Unless physician orders otherwise, the head of
bed should be elevated at 30 degrees.

 Acts to PCI 27. Disposes of soiled supplies appropriately and washes 3

improve hands.
clients’ health IPSG 5
condition or
human
response
(1.7.3.3)

KAR: LEGAL RESPONSIBILITY

1st 2nd 3rd 4th

JCI
Raw and
Competencies Standards Performance Criteria Remarks
Score 100 90 80 above
/ IPSG
% % % 70%

 Documents COP 28. Document in the patient’s progress notes: 3

care rendered  Assessment of the peristomal skin and stoma
to clients (4.3) AOP  Stoma measurements (length, width, height)
 Color and amount of drainage
 Any skin breakdown and peristomal skin care done
and type of ostomy pouch applied
TOTAL = 28 items 100

_______________________________________ ________________________________________
STUDENT FACULTY
 St Paul University Manila
(St Paul University System)

College of Nursing and Allied Health Sciences

SKILL TITLE: Administration of Enteral Feeding via Nasogastric Tube

NAME : _______________________________________________ SCORE: ____________

YEAR LEVEL/SECTION: _____________ DATE: ___________________

KAR: MANAGEMENT OF RESOURCES and ENVIRONMENT

JCI 1st 2nd 3rd 4th

Raw and
Competencies Standards Performance Criteria Remarks
Score 100 90 80 above
/ IPSG % % % 70%

 Identifies tasks COP 1. Validates chart for doctor’s order and check the 4
or activities that following documents:
need to be MCI - Feeding amount & schedule
accomplished
- Intake & output chart
(2.1.1)

 Adheres to PCI 2. Perform hand hygiene 4

policies,
procedures and IPSG 5
protocols on (Reduce
prevention and
the Risk of
control of
Health
infection (2.4.2)
Care–
Associated
Infection)

 Ensures proper COP 3. Prepares the following supplies on a tray. Checks for 4
functioning of flaws and expiration date.
equipment (2.3) - Feeding Tray
- Prescribed Feeding Solution
- Asepto syringe
- Glass with calibration
- Towel
- Stethoscope
- 30-50 ml water

KAR: SAFE and QUALITY NURSING CARE

 Explains PFR 4. Once inside the client’s room, greets the client and 3
interventions to introduces self and colleague nurse. Verifies client
clients and COP identity using 2 patient identifiers.
family before
5. Places materials and supplies in accessible area at
carrying them
out to achieve
bedside. Ensure privacy. Explains procedure and seeks 4
identified consent.
outcomes
(1.7.3.1) 6. If the client has previous feeding, determine for any
 Obtains alterations in bowel elimination, nausea and
comprehensive flatulence.
client
information
(1.7.1.4)
 Acts to COP 7. Position client in semi-fowler’s position. Cover the 3
improve clients’ patient’s chest. (Stand on client’s right if right handed
health condition and left side if left handed).
or human
response
(1.7.3.3)
8. Perform hand hygiene. 4

 Monitors AOP 9. Measure the exposed length of NGT from the exit 4
effectiveness of point.
nursing COP
interventions Check placement of the tube
(1.7.4.1) 10. Detach the clamp of the nasogastric tube and attach
the asepto syringe to the opened end of the tube.
Aspirate gastric content and measure the amount.
4
\

 Performs
nursing 11. Return aspirated residue to stomach if more than half
activities of the previously bolus feed or follows hospital policy
effectively and
in a timely regarding gastric aspirate
manner
 (1.7.3.4)

12. Remove the syringe from NG tube and to clear 4

aspirated contents. (Clamp the NG tube when
removing the syringe)

13. Connect the asepto syringe and introduce air into the 4
tube while auscultating the epigastric area with
stethoscope.

14. Remove the asepto syringe and dip the opened end of 4
the tube into the glass of water and instruct the client
to take a deep breath and exhale.

15. Pour the feeding solution into the barrel at the height 4
of 18-24 inches from the point of insertion. Raise or
lower the syringe if you need to adjust the flow to
ensure a slow instillation.

16. Refill feed in the syringe gradually. Avoid the syringe 4

from becoming empty during feeding to ensure to
prevent air entry. Observe the client during the
feeding process.

17. Pour water into the syringe after feeding and flush the 4
tube with 30-60 cc.
18. Clamps the tube and disconnect the syringe. 4

19. Have the client remain in Fowler’s position for 45-60 4

minutes.
 Analyzes the PFR 20. Informs client that the procedure is finished and 2
needs of addresses related concerns.
clients (1.4.2) 2
21. Assess client’s response to the procedure
22. Environment and safety: 3
e. Assist the patient in comfortable position
f. Pull side rails up
g. Place call bell within reach
h. Unless physician orders otherwise, the head of 4
bed should be elevated at 30 degrees.

 Acts to PCI 23. Wash and dry the syringe and other feeding 3
improve containers and return to proper place.
clients’ health IPSG 5
condition or
human
response
(1.7.3.3)

KAR: LEGAL RESPONSIBILITY

1st 2nd 3rd 4th

JCI
Raw and
Competencies Standards Performance Criteria Remarks
Score 100 90 80 above
/ IPSG
% % % 70%

 Documents COP 24. Document in the patient’s progress notes: 3

care rendered  Amount of the specific feeding formula
to clients (4.3) AOP  Time it was given
 Described the reaction of the client

TOTAL = 24 items 100

_______________________________________ ________________________________________
STUDENT FACULTY