[webblarsk]

Here is my dilemma with my patient. I spent 3 hours with her last night. Phenergan gel, Ativan gel still nauseated. Brief hx of this patient. COPD, end Stage, has feeding tube and trach. Friday afternoon son was feeding her (bolus feeding) She became nauseated immediatley. So, I assumed he fed her too fast. Did some patient/caregiver teaching. Held the feedings for 12 hours. As the night progressed she became more nauseated and began vomiting. So I figure the flu. She stopped vomiting but has been nauseated since. Son has held her feedings due to the nausea. Got a order this evening for Compazine supp. Son gave her 1/2 can of feeding and she became severely nauseated again. My gut says its just the flu or perhaps the formula. (But she has been on the formula for several months) What does everyone think? I need some input!

[letina]

Originally Posted by webblarsk

Here is my dilemma with my patient. I spent 3 hours with her last night. Phenergan gel, Ativan gel still nauseated. Brief hx of this patient. COPD, end Stage, has feeding tube and trach. Friday afternoon son was feeding her (bolus feeding) She became nauseated immediatley. So, I assumed he fed her too fast. Did some patient/caregiver teaching. Held the feedings for 12 hours. As the night progressed she became more nauseated and began vomiting. So I figure the flu. She stopped vomiting but has been nauseated since. Son has held her feedings due to the nausea. Got a order this evening for Compazine supp. Son gave her 1/2 can of feeding and she became severely nauseated again. My gut says its just the flu or perhaps the formula. (But she has been on the formula for several months) What does everyone think? I need some input!

Cyclizine? Haloperidol? Nozinan?
What about her bowels? Could she be constipated?

[RubyRN,CHPN]

Nausea related to delayed gastric empyting? Bowel tones? Residuals? Reglan works wonders for nausea r/t delayed gastric emptying.

[RubyRN,CHPN]

Nausea related to delayed gastric empyting? Bowel tones? Residuals? Reglan works wonders for nausea r/t delayed gastric emptying. Slow down the bolus feedings.

[webblarsk]

Originally Posted by RubyRN,CHPN

Nausea related to delayed gastric empyting? Bowel tones? Residuals? Reglan works wonders for nausea r/t delayed gastric emptying. Slow down the bolus feedings.

Checked all that. No residual. Good bowel sounds. Very regular bowel movements. The son and I had a talk about feeding very slowly and maybe giving less at one time. (Formula) I just feel really helpless with her being so nauseated. And we can't continue to hold her feeding. The woman needs some nutrition. Thanks for all your suggestions!

[aimeee]

Does she get the nausea with flushes? Or is it only with food? Have you tried a small amount of another formula to see if it might be tolerated? Is he giving the compazine BEFORE the feeding so it has a chance to take effect first?

[webblarsk]

Hey guys, thanks for all the input. My pt woke up today feeling much better. Took her feeding and her pills without nausea! Thank goodness!

[Severina]

I'm glad she's feeling better. I was going to suggest either Tigan IM or we have great successs with either DRA (decadron/reglan/ativan) gel, or BDR (benadryl/decadron/reglan) gel, scheduled either q6 hrs or q 4 hrs.
Also, isn't she a hospice patient? Why the concern at end of life with need of nutrition? The body naturally eshews food when it starts shutting down. Its one of the first things that happens. I find that sudden, difficult to manage symptoms, often herald the beginning of the active dying process. Just a little baffled here.

[webblarsk]

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[webblarsk]

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