G-tube question

  1. I have a student who has a G-tube. It is not used at school, they can eat and drink with no difficulties. Parents will not submit a Care Plan. I am curious as to why a G-tube is needed at all if the child is eating and drinking normally. They do not have a physical disability or chronic disease where I can see a G-tube would be necessary. Child has had for several years, so I'm thinking it's permanent. Am I missing something?

    Thanks
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  2. 10 Comments

  3. by   KKEGS
    The child has no health conditions listed? Are the parents forthcoming with information at all about his medical history? I had a student with a G tube that was not used at school because he had an eating disorder. He was physically able to eat and drink. He just wouldn't do it enough to satisfy his caloric requirements so the parents did a continuous feed at night in order to make sure he got enough calories. We didn't do anything with at school at all. We almost had to when he had a relapse of complete anorexia and we almost had to do bolus feedings at school but we didn't.

    I also have a friend whose son was born with Pierre Robin and cleft lip and palate and because of all of his surgeries and being unable to eat for such a long time developed severe oral aversion. Intensive therapy all around has gotten him to the point where he will eat some things orally but, again, not enough to satisfy his daily caloric requirement so my friend feeds him through his G tube at home to make sure his diet is balanced and adequate.

    Just some thoughts about why it might be there but not being used at school.
  4. by   OldDude
    Whatever...if it gets yanked out at school all you can do is put it in a zip-lock and call the parent. Otherwise, don't worry about it.
  5. by   mc3
    yes, that's what I plan to do. Why do that do they child if it isn't needed. She does not have any medical history indicating need for this that I can see. Just curious.....
  6. by   adventure_rn
    We've had NICU kids go home who take full PO feeds during the day, but are on continuous drip feeds at night.

    Without further info, it sounds like a tube was medically necessary back when it was placed, and now they've just left it in as a back-up. G-tube placement is far more invasive than removal, so perhaps the pediatrician is hesitant to remove if just in case it is needed again.

    Like OldDude said, probably not much you can (or need to) do about it.
  7. by   smartnurse1982
    Quote from OldDude
    Whatever...if it gets yanked out at school all you can do is put it in a zip-lock and call the parent. Otherwise, don't worry about it.
    The stoma will close up if you do that.

    I place it in the stoma without filling the balloon and tape it in place.
    Keeps the stoma open.
  8. by   OldDude
    Quote from smartnurse1982
    The stoma will close up if you do that.

    I place it in the stoma without filling the balloon and tape it in place.
    Keeps the stoma open.
    Well of course...but, as a RN, you can't do that if the parent won't provide an MD order for that contingency procedure along with her written permission. So, until that order and documentation is on file at your school, all you can do is watch, provide first aid, and notify the parent.
  9. by   Julius Seizure
    Quote from OldDude
    Well of course...but, as a RN, you can't do that if the parent won't provide an MD order for that contingency procedure along with her written permission. So, until that order and documentation is on file at your school, all you can do is watch, provide first aid, and notify the parent.
    If I was the school nurse, I might make sure mom/dad is aware of this (maybe in writing if you are concerned?) and they still don't provide you the necessary documentation, well...I guess they should hope it never gets pulled out.
  10. by   smartnurse1982
    Quote from OldDude
    Well of course...but, as a RN, you can't do that if the parent won't provide an MD order for that contingency procedure along with her written permission. So, until that order and documentation is on file at your school, all you can do is watch, provide first aid, and notify the parent.
    You would need an order to tape a g-button into the stoma?

    I do not have orders like that in homecare but we just tape in place until the kid gets to the ER.

    Some do have orders that Rn's can replace them(I do that often)

    I have worked as a school nurse but never thought about needing an order for that.
    I just thought of it as part of an emergency.
  11. by   cayenne06
    Quote from OldDude
    Well of course...but, as a RN, you can't do that if the parent won't provide an MD order for that contingency procedure along with her written permission. So, until that order and documentation is on file at your school, all you can do is watch, provide first aid, and notify the parent.
    Sit on our hands and put that kid at risk of needing surgery, because their parents didn't sign a form? I really don't know about that. That sounds like a bad plan.

    My kid has a gtube. Our school nurse just has a little note with the type of tube and the date of her surgery. I've always just assumed she'd pop it back in the stoma if it fell out, because that is the common sense thing to do. But now I'm going to have to call her lol.
  12. by   OldDude
    I'm not applying any of this to common sense... but this is the reality of being a RN, independent practitioner, with no medical director.

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