Paralytic Ileus

[LuAnnLeCronier]

Patient has been diagnosed with Ileus post obstruction. Pt has chronic low intestinal motility secondary to bilateral schizencephaly: quadraplegic spasticity. High metabolism requiring high caloric diet. Pt has JG. Pt is now receiving small amount JG feed: initiated in last 24 hours. 3am patient vomits large amount green bile...Resident comes in the morning to inform family that they are considering advancing patient from clear liquid diet to full liquid diet. I am questioning the appropriateness of this diet advancement. Does any one have some specific feedback?

[brillohead, ADN, RN]

Did you ask the resident who proposed the diet change?

Or is this homework you're wanting us to complete for you?

[LuAnnLeCronier]

The resident was proposing the change: Let's just say: it didn't happen. And, the family has asked that no other residents be a part of this patients care. Many other factor's involved: the family is requesting only doctor's and at this point due to other circumstances, specialists are needing to get involved.

As far as the homework, no.....I have that information. Thanks.

[Altra, BSN, RN]

A couple of general points:

"No more residents/students" is a common, understandable reaction on the part of family who are frightened of a patient's condition, or in denial about the chronicity of a patient's morbidities. It very often is not an accurate reflection of the quality of care actually provided by those members of the team.

In the last several years I have seen a shift towards tolerance of greater residuals, and, in simple terms, making sure that we are giving our patients adequate nutrition - not overreacting to every episode of vomiting.

And you know that residents are doctors, right?

[Kooky Korky, BSN, RN]

A couple of general points:

"No more residents/students" is a common, understandable reaction on the part of family who are frightened of a patient's condition, or in denial about the chronicity of a patient's morbidities. It very often is not an accurate reflection of the quality of care actually provided by those members of the team.

In the last several years I have seen a shift towards tolerance of greater residuals, and, in simple terms, making sure that we are giving our patients adequate nutrition - not overreacting to every episode of vomiting.

And you know that residents are doctors, right?

new, inexperienced doctors

[LuAnnLeCronier]

(smirk smirk) yes, I know what residents are...... This patient will be going for further GI evaluation. Actually the care by the primary team members is not in question.