# Situation: A 66-year-old man had a partial glossectomy and neck dissection for oral cancer. He receives continuous formula through a small-bore nasogastric (NG) tube whose position was confirmed by radiograph (X-ray) after insertion; the tube's mark reads 60 cm at the nostril. At 16:00 he coughs repeatedly, his oxygen saturation (SpO2) falls from 97% to 91%, and the tube mark now reads 48 cm at the nostril. Which conclusion should guide the nurse's action?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630473  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 66-year-old man had a partial glossectomy and neck dissection for oral cancer. He receives continuous formula through a small-bore nasogastric (NG) tube whose position was confirmed by radiograph (X-ray) after insertion; the tube's mark reads 60 cm at the nostril.

At 16:00 he coughs repeatedly, his oxygen saturation (SpO2) falls from 97% to 91%, and the tube mark now reads 48 cm at the nostril. Which conclusion should guide the nurse's action?

## 보기

1. The formula is flowing too fast for his stomach
2. Secretions from his operative site are pooling
3. The tube tip has probably moved up out of place **✔ 정답**
4. The cold formula is irritating his throat lining

**정답: 3**

## 해설

A change of 12 cm in the external length means the tube has been pulled back, and its tip may now lie in the esophagus, where formula can be regurgitated and aspirated. Coughing and falling oxygen saturation support this. The nurse stops the feeding, protects the airway, and obtains an X-ray before any further use.

## 심화 해설

A change in the external tube length
The tube's external mark read 60 cm at the nostril when its position was confirmed by X-ray. It now reads 48 cm, a change of 12 cm. A change of 12 cm in external length means the tube has been pulled back, and its tip may now lie in the esophagus, where formula can be regurgitated and aspirated. The new coughing and the fall in oxygen saturation from 97% to 91% support this conclusion.

Why displacement causes aspiration
A feeding tube is placed so that its tip lies in the stomach. If the tube is withdrawn, the tip can move into the esophagus. Formula delivered there flows back up toward the pharynx and can enter the airway, causing coughing, hypoxemia, and aspiration pneumonia. Clients after oral and neck surgery are at higher risk because of impaired swallowing and airway protection. Coughing, retching, or vomiting can themselves dislodge a tube, so the external mark is checked regularly.

Immediate actions
The nurse stops the feeding, protects the airway by keeping the head of the bed raised and suctioning if needed, monitors oxygen saturation and breathing, notifies the physician, and obtains an X-ray to confirm the tip position before any further use. The tube is not simply pushed back in, because the position must be confirmed after any movement.

| Option | Explains a 12-cm change? | Verdict |
| --- | --- | --- |
| Formula flowing too fast | No; causes distension or vomiting | Wrong |
| Pooled operative secretions | No; may cause coughing but not tube movement | Wrong |
| Tube tip moved up out of place | Yes | Correct |
| Cold formula irritating the throat | No; cold feeds cause cramping | Wrong |

Watch out! Secretions after oral surgery are a plausible cause of coughing, and that option is tempting. The objective clue is the change in the external mark, which only displacement explains.

Exam takeaway
Key point! A change in the external length of a feeding tube means the tip may be displaced; stop the feeding, protect the airway, and confirm position by X-ray before using it again.

## 임상 시나리오

Displaced Feeding TubeMark moved from 60 cm to 48 cm
The external mark moved from 60 to 48 cm, and the client is coughing with SpO2 down from 97% to 91%.

The tip has probably moved into the esophagus, where formula can be regurgitated and aspirated.

Stop the feeding, raise the head of the bed, suction if needed, monitor breathing, notify the physician, and confirm position by X-ray.

CautionDo not push the tube back in and resume feeding; position must be confirmed after any movement.

## 핵심 개념

- **External tube length** — The measurement at the nostril marking where the tube exits, used to detect tube movement.
- **Tube displacement** — Movement of a feeding tube tip out of its intended position.
- **Aspiration pneumonia** — Lung infection caused by inhaling food, fluid, or stomach contents.
- **Radiographic confirmation** — Use of an X-ray to verify that a feeding tube tip is in the correct position.

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