Regulating Feeding Times When Pt is Getting Continuous Feeding along with PO Feeding

[NURKeish]

Hello everyone, I am a new LPN who has been recently employed in pediatric home health. I know most people advise against home nursing for a new nurse, which I understand. However, what's a nurse to do after obtaining their license for 10 months and no job. I recently got a job in pediatric HH; the pay is not the best, but then what I am making, nobody was paying me that to stay home (unemployed). Most importantly, as a new nurse, I don't think I have reached the stage to put 'a big price on experience.' After all, I have none/ little, Lol

My pt is a child with cerebral palsy and has a G tube. Per order, the pt is on continuous feeding; each feed last 4 hrs, then vent for 30 mins, then the next formula mixture is started. Mom feeds the pt PO (advised by Dr) once during the day. She uses the same amount of formula (120 ml) that is fed by nurse, but adds a little corn starch for thickening. No problem there. I pause the feed to allow mom to do her PO feed. My concern is, how long after mom finishes feeding the child do I have to wait to re-start continuous feeding? Thanks

[JustBeachyNurse, LPN]

Did you ask the attending physician, GI physician, or speech pathologist what the recommendation is? Why not ask your RN clinical manager? This should be spelled out in the plan of care.

[NURKeish]

Its not in the plan of care. The mom said that she took the child for a Dr visit and enquired about PO feeds. The Dr suggested to mom that she could feed the child PO sometimes. I know that at times physicians verbally give options to parents, however, when it comes to a nursing duty, an order is usually in place. Even though it's mom who is doing the PO feeding, it has some bearing on the nurse's follow up actions. My options are to call the physician or ask my nurse manager. I'll try the latter first. Thanks for your response.

[Esme12, ASN, BSN, RN]

thread moved for best rsonse

[caliotter3]

When in doubt, ask the physician, or, when in doubt, ask the clinical nursing supervisor. Kudos to you for even questioning this. Many mediocre nurses would just continue with the feeding at their own timing without giving it a second thought.

[NURKeish]

Thanks

[brillohead, ADN, RN]

Actually, it sounds to me like you're doing Private Duty Nursing rather than Home Health.

PDN = shift work in the home, several hours at a time, usually 8-12 hour shifts.

HH = short visits to the home, visiting several different patients per day.

There's a totally different forum here at AN specifically for PDN: Private Duty Nursing Forum

[NURKeish]

I work in pediatric home care service. Yes, it's actually PDN, my perception of the term HH was wrong. Thanks for the clarification. I asked my nurse manager and she said that I could hold the feed for half hour. I told her that I hold the feed for one hour, then check the residual, and restart as appropriate (per residual policy). She said that was ok. As a new nurse, I am still curious as to how other nurses handle such cases on their jobs. I'll check out the PDN forum as suggested. Thanks

[Alex Egan, LPN, EMT-B]

In PDN the paperwork often lags behind the child's actual condition. In these cases I write an order based on what the parent tells me sign it and put it into action. I then call it in to the clinical manager (CM) the next morning. (I work nights) The CM has seven days (in the state of PA) to get it signed by the physician. If there is a miss communication is is fixed by the CM then. If the order seems strange or I don't feel comfortable with it I will advise the parent to carry out their wishes while I clarify things with the CM/MD (again night shift everything is done next day, no sense waking anyone up for something that can wait)

I use my phone, to type, I work at night, and I'm a bad speller. Pick any reason you want for my misspellings