Bilious Vomiting

Jolie, BSN · Nov 26, 2003

Yes.

I would do a thorough assessment of the baby documenting activity level (irritability or lethargy?), vs,(Any temp instability? Any change in baseline HR, RR or B/P? Any episodes of apnea or bradycardia? Any changes in color or O2 sat?) abd. exam, feeding history for at least the past 24 hours, elimination history for at least the last 24 hours, recent labs, especially chemistries, CBC and blood gasses.

I would insist that the doc in question personally examine the baby, and would request some basic orders, including holding feedings, adjusting IV intake, CBC, and abdominal X-ray.

If the doc is not willing to take these basic measures, and can't or won't offer a reasonable explanation as to why, then it is your responsibility to advocate for your patient by going up the chain of command to get the appropriate care. Your nursing supervisor is the person to help you with this.

Good luck. It's never easy to challenge a doc, but often it is necessary.

dawngloves, BSN, RN · Nov 27, 2003

I agree with Jolie. Check girth too. I've had this be nothing many a time. Real head scratchers

no-pain · Dec 1, 2003

As per your title "bilious vomiting", The facility I work at this is considered a surgical emergency until proven otherwise. So I agree, you perform your assessment, get orders for abd. x-ray, place a replogle to LIS, CBC with diff and provide respiratory support as well as going up the chain of command if that particular Dr. will not intervene.

Mimi2RN, ASN, RN · Dec 2, 2003

"place a replogle to LIS"

Would you please translate that for me?

:confused:

mimi

no-pain · Dec 2, 2003

low intermitent suction

mtre23 · Dec 7, 2003

At age three days this infant had suffered Temperature Instability, Feeding Intolerance, Lethargy, Increased amounts of Gastric Residuals turning to bilious vomiting by noon. Lavage c NS, Ab x-ray, bili and guiac of green- brown fluid ,that had been removed from infants stomach, was ordered by Doctor. By 3:00 p.m. day three a total of 45cc thick green- brown fluid was retrieved, ISO temp had been reduced to compensate for rising temp. These symptoms were followed by bloody stools.

The Doctor was notified but did not arrive at Nursery until approx 10:00 a.m. on day 4. Unfortunately the infant by this time was seriously ill. Transfer orders were issued and antibiotics started. The infant was diagnosed with Necrotizing Enterocolitis and as a result this infant ultimately suffered a intestinal perforation, requiring major emergency surgery and intraventricular hemorrhage associated with the complications of NEC.

Comments???

TiffyRN, BSN, PhD · Dec 7, 2003

I'm so sorry to hear of the way things progressed for this infant. Our unit is very vigilent about abdominal issues such as bilious residuals/vomiting, especially if associated with other signs of being sick such as temp instability or A & B's. We catch some NEC early but there isn't much to do other than treat supportively and antibiotics until there is something to treat surgically. We do however usually get abdominal x-rays every 6hrs. The good thing is that we have NNP's and Neonatologists present in the hospital at all times and they are quite responsive.

dawngloves, BSN, RN · Dec 8, 2003

Lavage? :eek: That sound risky in a neonate. Is this common?

What did the x ray show and why did it take so long for a doc to look at this kid?

mtre23 · Dec 8, 2003

Based on all my research Lavage is not considered a safe practice in a preterm infant. The x-ray revealed slightly prominent small bowel loops- ileus verse early obstruction. The Dr. was notified he gave no reason for choosing to not examine the infant further.

prmenrs, RN · Dec 8, 2003

I am concerned about HIPAA violation here--what is your connection to this pt, mtre23?

I am locking this thread til it can be discussed w/the other moderators. Please pm me w/your answer. Thanks.

dawngloves, BSN, RN · Dec 8, 2003

What level NICU is this? I definatley would have made some calls until someone was at the bedside.