Regulating Feeding Times When Pt has PO and Continuos 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

[NURKeish]

Mom said that the Dr said she could give feed the child PO for oral stimulation. I've asked mom questions including, if the Dr gave the amount to feed, how often (for oral stimulation it could be every two days, not necessarily every day). I further questioned what the speech/ swallowing therapist thinks of this. Mom says that the child had passed a swallow test. My concern is, why then has not the Dr written an order for PO feed. My clinical supervisor (CS) stopped by the pt's home recently and she touched on the issue with mom who told my CS the same things she told me (things I wrote in the post). My CS questioned if the speech and swallow therapist gave clearance for this, if there is a PO feed order (CP knew there's none), as well as who recommended cornstarch for thickener. Now these parents are really something, because mom was quick to point out that she (mom) was doing the feeding and not the nurse and in her opinion the child tolerates PO feed well. Also, that the Dr had said she could. My CP strongly encouraged her to get an order, she even went as far to tell mom that if there is an order, the nurse can do the PO feed. The child has a Dr appointment coming up in a few days so mom said she will request the order at that time.

My CP says if the Dr tells mom (not nurses) she can feed PO, we cannot say no. However, the nurses need clear pre/ post feed instructions, example how much H2O flush the child should get. The order we have for H2O flush is in relation to the continuous feeding, not PO. The important thing is that the nurses are not doing the PO feeding and nurses are documenting re the issue. I've been doing my documenting, checking residual, etc, and I will continue.

[SDALPN]

Looks like trouble, sounds like trouble....its trouble.

Don't believe a parent until they have proven they are honest...that includes making sure the parent doesn't leave stuff out. Trust me, this advice comes from experience. If it hasn't come from the Dr or you haven't seen it in writing, its not fact. Even if a parent doesn't lie, they can get confused. How many of us could go to an auto mechanic and repeat everything exactly a few days later?

I've had a few parents tell me their kid passed a swallow study, only to find out the kid has restrictions or never passed. But the parent wants to push what the child isn't ready for. This applies to other things too.

You can't prove all of us are nurses. The best thing to do is contact your supervisor and the physician for clarification and policies. Simple as that.