[dayshiftnurse]

hi,
wondering about a situation i had the other night. just want feedback to make sure i did the best thing and also for the next time.

had a patient, back from hemo and generally looking unwell. got him settled in, vss slightly tacky, afeb. restarted feed in head up posn' and thought things were going well. later came around to do mouth care and noticed was attempting to cough/wretch. i thought it would settle, but then he vomitted about 200cc of the feed.

i stopped feed. cleaned him--tried to do his mouth FIRST to avoid aspiration. then face/body/change gown etc. i rechecked mouth to make sure it was clear and then did more mouth care/resp care with suctioning.

i waited 1/2 hour and gave him 25mg gravol and still kept feed off.
about 1 1/2 hour after that i restarted feed at a low rate of 30 cc/hr (originally 60cc/hr) in 70degree head up. i could have given gravol IM but i didnt want to cause him more pain/disturbance.

he looked better after throwing up and vss better too. i didn't call the md, because he seemed to tolerate the restart of feeds okay, but endorsed to next shift to keep an eye. and the wife was there so no need to notify family.-------------

any suggestions on anything i could have done better and performed better? what about the gravol peg vs. im? do you better idea/rationale?

thank you!!

[rnmi2004]

Does your facility have a standing order/flowsheet type of thing for people on tube feedings? That would tell you what to do if the pt isn't tolerating feedings. The one at my hospital is specific about how often to check residuals, free water flushes, when to hold, what rate to restart. If the pt is coughing/wretching, it is a good idea to check residuals & go from there.

[strong_willed]

if there are no standing orders or flowsheet, check your nursing care policy/protocol manual (most facilities have one). That should help you through just about anything. If not sure, ask your coworkers, they should be able to direct you to the correct resource. If none of the above is available, talk to your supervisor to see about getting a protocol in place.

[jmgrn65]

Residuals should be checked before restarting tube feeds, especially after they have been held for vomiting. I also agree with the op to check with your hospitals p/p.