RE: Need help fast!!

[Guest guest]

Carmen:

After reviewing the information below I would say that you might be a little over cautious. Unless your patient is having some GI problems or symptoms the pouch is probably fine. I do not think there is any reason to do TPN if she can tolerate the tube feeding. Bolus feeding may be an issue but continuous feeds are probably fine because there is minimal amount of feed in the stomach at one time. If you are worried about dumping syndrome a lower carbohydrate formula may be helpful. As far as bowel movements go, I would watch for abd distention and maybe an enema is in order if she does not have a BM soon..if she goes too long without a BM then she probably needs a CT for bowel obstruction. I hope this helps.

Laschkewitsch RD

Need help fast!!

I have a patient S/P gastric bypass 1 year ago. She was admitted for suicide attempt (this is the third attempt). She took 3 bottles of Dalmane. No one has taken note, except me, that she has the bypass hx. She has been intubated twice, bronched, CTs placed, NGT to LIS (then D/C), and MFT placed. I cannot find documentation of gastric lavage (thank goodness). All of these procedures have been done with no apparent realization that she is S/P gastric bypass.

I became aware of the pt when I got an order for Pulmocare FS @ 40 cc/hr. Upon reviewing the chart, I found the hx. She has been receiving the feeding for about 24 hrs now, and the GI doc (who is covering for the one on the case) doesn't seem to think there is a problem. I want to hold the Pulmocare. I think they should check the patency of the pouch, and if all is well either feed Osmolyte FS @ 20 cc/hr into the pouch w/TPN or surgically place a j-tube and feed her that way. Am I being overly cautious? By the way, she has not had a BM since feeding started, and when a KUB was done, there was no notation of the bypass, just that the MFT tip was in the proximal portion of the stomach. Maybe I'm crazy......

Any suggestions are truly appreciated, I have never dealt with a case like this before.

Carmen

Carmen Urrunaga, MS, RD, LD/N Clinical Nutrition Manager Kendall Regional Medical Center 11750 Bird Road Miami, FL 33175 305 223-3000 x2273 carmen.urrunaga@... visit us at: http:\\www.kendallmed.com This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing, or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email or contact the sender at the number listed.

-----Original Message-----From: Simler [mailto:vsimler@...]Sent: Thursday, December 09, 2004 11:33 AM Subject: Re: bariatric coordinator job descriptionGood job, Leah. Hope others will benefit from our efforts. Hopefullymore RDs will be taking this role in programs in the future. Simler, MS, RD, CDEValleyCare Health SystemPleasanton CA>>> leahwalters@... 12/09/04 06:17AM >>>FYI.I added my job description to the available files.I credit for helping me with writing my own last fall.Good luck.Leah Walters

[Guest guest]

Pulmocare is a lower carbohydrate formula. I agree with not being overly

concerned, but keep an eye on the Pulmocare- it is high fat and delayed

gastric emptying with increased residuals can be a problem.

Rita , RD, LD/N

Clinical Nutrition Manager

Memorial Hospital of Tampa

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12/27/04 05:24 PM

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RE:

Please respond to Need help fast!!

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Carmen:

After reviewing the information below I would say that you might be a

little over cautious. Unless your patient is having some GI problems or

symptoms the pouch is probably fine. I do not think there is any reason to

do TPN if she can tolerate the tube feeding. Bolus feeding may be an

issue but continuous feeds are probably fine because there is minimal

amount of feed in the stomach at one time. If you are worried about

dumping syndrome a lower carbohydrate formula may be helpful. As far as

bowel movements go, I would watch for abd distention and maybe an enema is

in order if she does not have a BM soon..if she goes too long without a BM

then she probably needs a CT for bowel obstruction. I hope this helps.

Laschkewitsch RD

Re: bariatric coordinator job

description

Good job, Leah. Hope others will benefit from our efforts.

Hopefully

more RDs will be taking this role in programs in the future.

Simler, MS, RD, CDE

ValleyCare Health System

Pleasanton CA

>>> leahwalters@... 12/09/04 06:17AM >>>

FYI.

I added my job description to the available files.

I credit for helping me with writing my own last fall.

Good luck.

Leah Walters