What would you do in this situation?

Nascar nurse, ASN, RN · Nov 18, 2008

YOU should call and get an order to hold the feeding. Also, someone needs to be evaluating why this lady is vomiting so much. Is the HOB up?, how much does she actually eat orally daily (ie: does she need that much feeding), what is the residual prior to starting feeding?, does she have a problem tolerating the particular formula she is on? Does the Dr. even know she is having a problem or does most nurses just keep feeding and putting it on hold, therefore the problem never gets fixed.

Just remember, you can be part of the solution.. feel free to pick up the phone and call the Dr., especially when no one else seems to be following up. Good luck with your resident!

caliotter3 · Nov 18, 2008

If someone has thrown up I would leave the feeding off for 30 minutes and chart that action. You should contact the doctor to see if he will give an order to hold the feeding. Most continuous feeding orders will state circumstances to hold or stop the feeding. One of my patients had a complete protocol to use if he was sick, throwing up, etc. It involved slowing down the feeding and diluting it down. The RN primary nurse got orders for this when it became apparent that the patient had persistent feeding problems.

mondkmondk · Nov 18, 2008

YOU should call and get an order to hold the feeding. Also, someone needs to be evaluating why this lady is vomiting so much. Is the HOB up?, how much does she actually eat orally daily (ie: does she need that much feeding), what is the residual prior to starting feeding?, does she have a problem tolerating the particular formula she is on? Does the Dr. even know she is having a problem or does most nurses just keep feeding and putting it on hold, therefore the problem never gets fixed.
Just remember, you can be part of the solution.. feel free to pick up the phone and call the Dr., especially when no one else seems to be following up. Good luck with your resident!

I totally agree but am only a weekend nurse; however, when I work next, I will take a look at her care plan to see if this has already been addressed. I know she has an order to keep HOB up to 45 degrees, but she scoots herself all around and we have to pull her up repeatedly during the shift. If no one has addressed it in the care plan, I will call the DON and see if I can have permission to go ahead and send a fax to her doctor. Thanks again!

Blessings, Michelle

rn/writer, RN · Nov 18, 2008

Is anyone looking into why she's throwing up so much? Is it possible that she's not tolerating that particular product? Could the rate be more than she can handle? Is she checked in the AMs (after the tube feeding is dc'd) for residuals?

Why is she being tube fed if she can eat during the day? If it's to increase her caloric intake, you have to wonder how many calories she is losing with the vomiting.

I guess I'd be calling the doc to let him know this is a recurring situation and asking about alternatives and to clarify if the feeding should be held for X amount of time after a vomiting episode.

Addendum: Looks like we're all on the same page. While I was writing my post, other people asked the same questions. I feel for this poor lady. Hope you can find a way to help her.

mondkmondk · Nov 18, 2008

Is anyone looking into why she's throwing up so much? Is it possible that she's not tolerating that particular product? Could the rate be more than she can handle? Is she checked in the AMs (after the tube feeding is dc'd) for residuals?
Why is she being tube fed if she can eat during the day? If it's to increase her caloric intake, you have to wonder how many calories she is losing with the vomiting.
I guess I'd be calling the doc to let him know this is a recurring situation and asking about alternatives and to clarify if the feeding should be held for X amount of time after a vomiting episode.
Addendum: Looks like we're all on the same page. While I was writing my post, other people asked the same questions. I feel for this poor lady. Hope you can find a way to help her.

When I was still orienting, her daughter came in one night and did tell me that this particular feeding (Jevity) was the only one she could tolerate in the hospital. I assume since her massive brain aneurysm (sp?) she has been through a lot. She threw up while her daughter was still there and the daughter acted like it was just a normal everyday occurence.

Thanks though for all the responses; I will be sure to make time to read her whole chart when I work again!

Blessings, Michelle

Blee O'Myacin, BSN, RN · Nov 18, 2008

Does anyone check residuals on this patient? I suppose that I would initally have held the TF for 30mins, checked the residual and called the doc for an order to either keep holding or to restart at a low rate, checking the residual every two hours or so. Also, I'd be keeping tabs on the blood sugar and electrolytes, especially in light of the vomiting.

I'd also be concerned about absorption of meds that go through the g-tube.

I notice that this is a LTC patient, and I am looking at it from the perspective of a unit patient - but I still don't think I'd do anything differently (other than sending labs off -- since you can't do that in the middle of the night like I could on the unit).

Also, why dramamine? Does she have vertigo? What about some reglan instead? This definately needs some intervention from the doc.

Blee

achot chavi · Nov 18, 2008

Sometimes the Gtube is the problem, it could be in wrong - (it could have been fine when they put it in and turned around while in the stomach).

I would ask for a Gastroenterology consult.

I the meantime document, report problems to the doctor, and check the gtube for excess stomach content by aspirating with a 60 cc syringe. If there is more than 50 cc in there, call the doc. Make sure the HOB is elevated at least 45 degrees. if you think the food will spoil- put ice in the kangaroo pouch.

All good nursing practice that you already know.

CoffeeRTC, BSN, RN · Nov 18, 2008

All great advice. I second the gastro consult. The tube can be causing an irritation.

Why not reglan? I remember using propulsid yrs ago for these type of tube feeders (vomits alot)

As far as notifiying the doc....why do you have to aske the DON? Even if it is the weekend....I still call. (just not late at night for an ongoing problem like this)

lpnflorida · Nov 18, 2008

It does sound like having a GI consult would be in order.

In the hospital we use reglan qid for many of our tube feeders that and I want to say prevacid. It is a type of pill which we dissolve in water before putting it in the tube. If I am wrong on it being prevacid maybe someone else can come up with the name I am having a brain farct I think lol.

CoffeeRTC, BSN, RN · Nov 18, 2008

Nope...most of our tube feeders have prevacid ordered too.

mondkmondk · Nov 19, 2008

All great advice. I second the gastro consult. The tube can be causing an irritation.
Why not reglan? I remember using propulsid yrs ago for these type of tube feeders (vomits alot)
As far as notifiying the doc....why do you have to aske the DON? Even if it is the weekend....I still call. (just not late at night for an ongoing problem like this)[/
She gets Reglan liquid at hs...I think she actually gets it bid.
Thanks for all the responses; all great ideas as to what I could do!
Blessings, Michelle