NAME: Shiela Ann Marie M.

Anama YEAR/SECTION: BSN 3Y1-5 GROUP: 17-A

Nasogastric suction
Nasogastric suction involves removing solids, liquids, or gasses from the stomach or small intestine by inserting a tube through the nose and suctioning the gastrointestinal material through the tube.

Purpose
Nasogastric suction may be done in the following situations:

to decompress the stomach or small intestine when intestinal obstruction (ileus) is suspected prior to gastrointestinal operations to obtain a sample of the gastric contents for analysis to remove toxic substances to flush the stomach during gastrointestinal bleeding or poisonings

Nasogastric intubation, the insertion of a tube through the nose into the stomach or small intestine, is also done to temporarily feed certain patients. In this case, material is not suctioned out.

Precautions
Nasogastric tubes cannot be placed in patients who have blockages in their esophagus, enlarged esophageal veins or arteries that might bleed, or severe damage to the jaws and face. The tube cannot be inserted in a patient who is having convulsions, or who is losing or has lost consciousness unless a tube has been inserted into his or her airway (intubation).

Description
The patient sits upright while a lubricated tube is slipped through the nose and down the throat. The patient may be asked to sip water at a certain point in the procedure to facilitate the passage of the tube. If the tube is to be placed into the small intestine, the doctor may use an endoscope to help see where the tube is going. Once the tube is in place, material can be removed from the stomach or intestines with gentle suction.

There are several different types of nasogastric tubes, each with a different purpose. Tubes used for stomach flushing are called orogastric tubes and are the largest in diameter. Tubes that are threaded through the lower opening of the stomach (pylorus) and into the small intestine are stiffer and have a balloon tip. Other specialized tubes are used for long-term and short-term feeding.

Preparation
Little preparation is necessary for this procedure other than educating the patient as to what will happen. The patient should remove dental appliances before the nasogastric tube is inserted.

Aftercare
After the tube is removed, no special care is needed. The patient's throat may feel irritated from the presence of the tube.

Risks
The most serious risk is that the patient will inhale some of the stomach contents into the lungs (aspiration). This may lead to bronchial infections and aspiration pneumonia. There is also the chance that the tube will be misplaced in the windpipe (trachea), causing violent coughing. Irritation to the throat and esophagus can cause bleeding.

Normal results
Nasogastric suctioning is normally well tolerated by patients and is a temporary treatment, performed in conjunction with other therapies.

What is bleeding?
Bleeding is the loss of blood from the circulatory system. Bleeding can occur internally, where blood leaks from blood vessels inside the body or externally, either through a natural opening such as the vagina, mouth or anus, or through a break in the skin. The complete loss of blood is referred to as exsanguination, and desanguination is a massive blood loss. Loss of 10-15% of total blood volume can be endured without clinical sequelae in a healthy person, and blood donation typically takes 8-10% of the donor's blood volume.

Causes, prevalence, and risk factors

Hemorrhage generally becomes dangerous, or even fatal, when it causes hypovolemia (low blood volume) or hypotension (low blood pressure). In these scenarios various mechanisms come into play to maintain the body's homeostasis. These include the "retro-stress-relaxation" mechanism of cardiac muscle, the baroreceptor reflex and renal and endocrine responses such as the renin angiotensin - aldosterone system ( RAAS). Certain diseases or medical conditions, such as hemophilia and low platelet count (thrombocytopenia), may increase the risk of bleeding or may allow otherwise minor bleeds to become health or life threatening. Anticoagulant medications such as warfarin can mimic the effects of hemophilia, preventing clotting and allowing free blood flow. Death from hemorrhage can generally occur surprisingly quickly. This is because of ' positive feedback'. An example of this is 'cardiac repression', when poor heart contraction depletes blood flow to the heart, causing even poorer heart contraction. This kind of effect causes death to occur more quickly than expected.

Types of bleeding
A subconjunctival hemorrhage is a common and relatively minor post- LASIK complication. Hemorrhage is broken down into 4 classes by the American College of Surgeons' Advanced Trauma Life Support (ATLS).

Class I Hemorrhage involves up to 15% of blood volume. There is typically no change in vital signs and fluid resuscitation is not usually necessary. Class II Hemorrhage involves 15-30% of total blood volume. A patient is often tachycardia (rapid heartbeat) with a narrowing of the difference between the systolic and diastolic blood pressures. The body attempts to compensate with peripheral vasoconstriction. Skin may start to look pale and be cool to the touch. The patient might start acting differently. Volume resuscitation with crystalloids (Saline solution or Lactated Ringer's solution) is all that is typically required. Blood transfusion is not typically required. Class III Hemorrhage involves loss of 30-40% of circulating blood volume. The patient's blood pressure drops, the heart rate increases, peripheral perfusion, such as

capillary refill worsens, and the mental status worsens. Fluid resuscitation with crystaloid and blood transfusion are usually necessary. Class IV Hemorrhage involves loss of >40% of circulating blood volume. The limit of the body's compensation is reached and aggressive resuscitation is required to prevent death.

Individuals in excellent physical and cardiovascular shape may have more effective compensatory mechanisms before experiencing cardiovascular collapse. These patients may look deceptively stable, with minimal derangements in vital sounds, while having poor peripheral perfusion (shock). Elderly patients or those with chronic medical conditions may have less tolerance to blood loss, less ability to compensate, and may take medications such as beta blockers that can potentially blunt the cardiovascular response. Care must be taken in the assessment of these patients.

What is bowel rest?

Refreshing ease or inactivity after work or exertion in the intestine. To be or become quiet, still, or inactive.