Agitated Pt Makes for Hard G-Button Feedings

JustBeachyNurse, LPN · Aug 9, 2015

Not sure you have the right word "exacerbates" himself, nor am I sure what you are trying to say

I'm guessing he increases his intraabdominal pressure so that a gravity bolus is not able to flow freely?

Are these bolus feeds you are doing by gravity? Do you vent first? You may very well be causing pain if there is a gas pocket and you do a bolus feed

Can you do a syringe feed or via pump?

LVN2BSN2016 · Aug 9, 2015

No vent. He's just being a kid. His mom says he does this all the time. And yes, it's bolus by gravity. He starts doing it as soon as walk over to him and he knows he's about to be fed.

No syringe and no pump.

JustBeachyNurse, LPN · Aug 9, 2015

Not vent as in ventilator

Vent the GT as in its standard orders. Attach bolus extension with 60mL empty syringe with no plunger unclamp extension. Any built up gas pressure will vent out the tube as will excess residual. You should be venting and checking residual before every bolus feed anyway. If you aren't venting his belly, it may very well be uncomfortable to be fed via gravity bolus without releasing excess gastric pressure/air.

LVN2BSN2016 · Aug 9, 2015

Ok I don't appreciate you speaking to me like I'm an idiot. Thanks.

enuf_already · Aug 10, 2015

Ok I don't appreciate you speaking to me like I'm an idiot. Thanks.

I didn't take what JustBeachy said as speaking to you like you were an idiot.

We all know autocorrect changes words and the written word is not always taken as it would be spoken. I believe JustBeachy was trying to clarify several things and offer advice.

JustBeachyNurse, LPN · Aug 10, 2015

Ok I don't appreciate you speaking to me like I'm an idiot. Thanks.

I am sorry you have chosen to misinterpret the written word. I am not speaking to you like you're an idiot. You responded no vent, I simply clarified what I meant by vent---a method of releasing gastric pressure/excess gas.

You previously posted that you are a new grad that started in PDN with minimal training and no experience. I used to be surprised at nurses that never knew what venting a GT or how to do it, but not anymore. I'm no longer surprised at the number of nurses that don't think to vent GT to release excess gas and check residuals. Many children with CP also have a fundoplication and reduced ability to burp. It seems your child is non-verbal and cannot tell you why he reacts to the thought of a bolus feed.

Some children distraction such as a preferred tv show works

I assumed your original post might be a victim of autocorrect.

JustBeachyNurse, LPN · Aug 10, 2015

I'm still not sure what you were trying to communicate here

and nearly exacerbates himself from pushing so hard.

exhausts? Eviscerate? Expel the GT? Exacerbate means to aggravate or make a problem, condition or bad condition worse. You can exacerbate a condition but not yourself.

I attributed the word to autocorrect.

Many parents are never shown how to vent a GT or forget. I've had children that the primary nursing team insists never needs venting but the child gets restless whenever the feed gets set up. I decided to try and vent the GB just to see (it's a standing order for all tube fed children, especially if they have a fundoplication)and the amount of gas expelled seemed disproportionate to the size of the child's GI tract!!! Child relaxed and the feeding was run without issue as the child played.

It's a simple intervention that could make your job a lot easier.

If the child is restless from discomfort maybe a syringe bolus or pump bolus over 30 minutes would be a more comfortable alternative if venting prior to giving the feed doesn't work. Of course you would need to communicate this to the supervising RN and treating provider to get an appropriate order.

SDALPN · Aug 10, 2015

So I'm taking care of a young pt with cerebral palsy, and getting him to cooperate during his feedings is near impossible.
The second the connection snaps into his G-Button, he pushes out his stomach and nearly exacerbates himself from pushing so hard. Feedings take almost 45 minutes....and I have to do it multiple times a day! I've tried rolling the tube between my fingers, pinching it in different places to get the liquid flowing, but he beats me every time.
Any tips on getting a kid to cooperate during feedings?

You stated that the child has CP. Its not a matter of cooperation. Sometimes the child can't control their movements if the CP is severe enough. If the child has anxiety, the anxiety may show itself with increased movement and increased muscle tone. It takes a lot of patience with these kids at times. You have one patient and all day, there's no rush.

I saw someone post that you are a new grad. If this is true, you are in the wrong area of nursing at this time. PDN isn't for new grads. It sounds like you have a lot to learn and your company is at fault for not training you. The majority of agencies won't train you or won't train you appropriately. They want a warm body with a license. They don't care about you or your license. Read through the forum and see what I mean. None of this is to be mean. It's just how it is.

CloudySue · Aug 20, 2015

I didn't see anything here either that indicated that they thought you were an idiot. If these responses upset you so easily, you may want to take a hard look on how you take constructive criticism and consider processing it in a healthier way. The only thing more concerning to me than a new nurse in PDN is a new nurse in PDN that cannot gracefully handle taking advice and concerns from other, more experienced nurses.

lucylight · Aug 20, 2015

Definitely vent first, your patient may need vented multiple times a day if you are having a lot of problems with extra gas.

Then prime the tubing. That will help with getting it flowing from the beginning and from getting extra gas.

Recline the patient a little.

Distraction can help sometimes if they are fighting but I usually remove stimuli and try to make a calm relaxing environment. But I have issues with when my patient gets overly excited during a feeding.

if you are getting a lot of residual, report that, let parents know, case manager,

Doctor...they may need to change up how the feelings are administered.

I am a newer nurse and work in a private duty/home health field. My company gives excellent and unlimited training of course for a lower pay rate than my usual.