GT meds when pt eats PO

lvnhopeful · Oct 22, 2008

I can't answer your question Calilvn, but I sure would like to know the answer to it......

Hoping someone responds.

DDRN4me · Oct 22, 2008

Sometimes the meds are difficult to swallow or the pt is unable. what kind of po diet?

perhaps if you gave the meds right after some food like crackers etc it might not make him sick.

or he might need an antacid.

but he needs to have the meds as prescribed or you need to let the MD know.

x0x0CaliLVN · Oct 22, 2008

The patient's diet is Mechanical Soft, NCS Extra Gravy, Thin Liquids.

I forgot to add he has a diagnosis of Pancreatitis if that matters or not...

I googled Valproid Acid and Pancreatitis and I believe I saw it shouldn't be given if pt has that diagnosis or it may actually cause it..

Anyway, the pt asks the meds, which are scheduled at 5pm, be given after dinner so I give around 6pm when he is finished.

SuesquatchRN, BSN, RN · Oct 22, 2008

I used to combine everything. They end up combined in the stomach anyway.

I'd like to know why the meds are via gt, as well.

Pediatric Critical Care Columnist · Oct 23, 2008

When compliance is an issue, the meds might be given via GT to ensure the patient gets them. We will often give kids meds via NG or NJ even though they're feeding orally because we know they'll refuse them or spit them out because they taste bad, or just because we know we won't get them to swallow them. I work with kids who have heart conditions and kids who have had transplants; they take lots of vital meds for long periods of time and we can't horse around with cajoling, pleading, threatening and trickery. The tube is often literally a life-saver! Kids have told me that when they get their meds via tube, they sometimes feel nauseated or they gag, or they have stomach upset... if the meds are given too fast! This is especially the case when we use an NJ for meds, but what they feel then is cramping, because the jejunum isn't meant for rapid instillation of anything. When they get the meds (and the flush too) trickled in and are distracted a little while the meds are going in, they don't seem to have these issues. As for mixing them all together, there are few oral meds that have physical interactions, unlike the huge number of parenteral meds that precipitate or neutralize others. And of course, if you're giving 10 meds one after the other by the same route, they are all going to mix anyway.

Valproic acid is an anticonvulsant that is used for seizure disorders unresponsive to more commonly prescribed drugs. Changing from it to something else takes quite some time, so although this patient has pancreatitis, perhaps the physician chose to continue with it because the risks with making a switch were higher than those of continuing.

x0x0CaliLVN · Oct 23, 2008

thanks for all the replies! the pt is compliant with all aspects of care...that i've given/seen so i'm not sure if that is the issue ( him spitting meds out/refusing) but i'm not sure... also, the valproic acid, in his case, is given for bipolar disorder. well i'm gonna ask my coworkers when i go in on thursday. thanks again!

litbitblack, ASN, RN · Oct 23, 2008

does he have the tube due to his swallowing? or something else. Some people have to get a feeding tube in preparation for needing it later like in radiation of the throat. Once they have the tube and have trouble swallowing whole pills why not put them in the tube. They can all be crushed together except for ones that say specifically like dilantin. Once someone has been using a tube for a while they prefer to just put the meds in it rather than tasting them. ANd i suppose the reason for waiting an hour after eating per his request is hes probably full and the medicine and flush would be to much

Snickers&DtCoke · Oct 25, 2008

I care for a woman that is only fed via G-Tube. She has a very sensitive gag reflex. We seem to have BETTER luck (not always a sure thing) if we do not push anything... let gravity work, not plungering the meds. And also room temperature/lukewarm fluids seems to make things easier. But nothing is a sure thing with her... she'll tighten up or cough or sth and refill (nearly overflow) the syringe! YIKES!

Sounds like maybe resident could have a talk with the doctor about his meds if he is able.

sasha2lady · Mar 11, 2009

OH man...Im glad I found this post!....I have a very similar case..I have a woman who is just...eat up with endo Ca....she has a peg tube but can take her meds either po or peg....she has a regular diet..but too suffers from extreme n/v if she puts anything in her mouth...she cant really eat without vomiting...even just bites will do it...and when we were doing her meds po...never failed..shed throw up...except.....for her pain pill or sleep pill...now..she would take those and keep them down just fine...anything else...no way...so we give them all via peg now and she has no n/v from her meds .. only from po food now. She is also on a continuous feeding too..via the peg and doesnt have any n/v from that either. If i had to guess...i would say that in her case its a combo of psychosomatic problem and her meds are just easier to absorb straight in the peg to the stomach. I thought it was odd that she would vomit up any med po if it was one she didnt ask for. and if she vomits at breakfast....she wont even attempt to eat anything else the rest of the day...it just does her in.