Persistent Vomiting with Feeding Tube

[Aneroo, LPN]

I am the school nurse, therefore I am the expert, and get all sorts of questions.

A coworker has an adult son who in wheelchair bound and gets bolus feedings bid. Has tolerated this without problems for years.

In a MVC two weeks ago. Went to ER with CT and x-rays (puncture wound to abdomen). Reported that there was no damage to tube, and since then the puncture wound has healed.

However, since the MVC he has been vomiting after his feedings. Has gone to his PMD who suggested decrease the amt. of feedings, and that has not worked either. Vomiting is really bad for this kid, b/c soon he'll end up in the hospital for aspiration pneumonia if it keeps on.

Any suggestions or ideas as to what is causing this? This is an area I am not very experienced in and wasn't able to offer much help.

[leslie :-D]

how are his bm's s/p abd trauma?

first thing i'd want to r/o...

leslie

[Whispera, MSN, RN]

agree with earle! could be his small or large intestines are damaged and food can't get through, so it has to come back up

[tryingtohaveitall]

It sounds like he definitely needs further eval by a ped surgeon or peds GI dr.

[morte, LPN, LVN]

yup, if it cant go down, it's gonna go up.......def need eval on that puncture wound.....perhaps it has only healed on the outside and adhesions etc on the inside?...

[nerdtonurse?, BSN, RN]

I'm thinking this kid has got a small bowel follow thru in his future...

[Aneroo, LPN]

Thanks guys. We're a pretty small town, and she went to the PMD, but I don't know if it is a plain ol' general med doctor or if it was a gastro specialist. She said the doctor ran out of ideas, and I'm screaming in my mind "That's not good enough!"

I'll encourage her to return or request a referral to see someone else. Another part of the problem is positioning- his wheelchair was broken during the accident, so she isn't able to get him into the best position for his feeding either.