d. Encourage the patient to swallow saliva naturally; the tube is a constant source of annoyance and the patient may have a tendency to expectorate excessively. The physician may allow chewing gum or hard candy to help maintain mouth moisture and to encourage normal swallowing of saliva. Only conscious, responsive, alert patients should be given these items.

CAUTION: Remind the patient to remove gum or candy before mouth care and sleep.

e. Report complaints and signs of nose or throat irritation (excessive mucus, sore throat, or hoarseness).

f. Encourage the patient to change position frequently, using care not to pull on the tube and not to lie on the drainage tubing.

g. Follow diet orders exactly. If water or clear fluids are allowed by mouth, be sure to check on amount to be given at one time. Know exactly whether or not the tube is to be clamped when fluids are given and at what time interval in relation to oral intake. For example, the order may be to clamp the drainage tube for 1 hour after intake to allow some absorption.

h. Keep accurate intake and output records. Large amounts of fluid and electrolytes are lost during continuous suction drainage. Information on all in-take and all output is used by the doctor in planning fluid replacement.

i. Observe the patient frequently when he is asleep, noting the tube marking at the nostril. The patient may have unknowingly pulled the tube out partially or completely. If partially out, advance the tube to the required point and check for drainage. Tape securely. If the tube has been accidentally removed, notify the nurse or doctor. Reinsert only on order.