Camille Gregorio

St. Joseph's Regional Medical Center

Gastrointestinal Disorders

ADIME notation

Preceptor Eleanor Schiavo, MS, RD

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74 y/o M with pancreatic malignancy s/p Whipple procedure admitted to SICU. Immediately after the surgery, he was extubated. Per RN notes, there was "scant amount of greenish gastric content, nothing in the canister" of the NGT drainage and 120 ml total JP drainage. If he remained NPO x 3 days, I suggested initiating nutrition support and to continue monitoring drainage trends.

I reassessed the patient the following day. He remained NPO, with minimal NGT drainage. He was on D5 1/2 NS IV fluid, providing 155 kcal and 410 ml water. Before making a recommendation, I consulted with Dr. Della Torre, who had performed the surgery. As the patient's GI tract begins to show functional signs, the physician was going to advance his diet by Saturday (2 days from current date) to a clear liquid diet as tolerated. Noting a drop in albumin, I suggested adding 30 ml Prostat twice a day with clears. If he is able to tolerate the clears, I suggesting advancing his diet to a 40 g fat diet with 30 ml Prostat twice a day, 4-6 small meals per day. Due to the severity of this surgical procedure and the implications of malnutrition, I also suggested monitoring glucose trends, stool content for steatorrhea, JP drainage for pancreatic enzymes (as evidence of malnutrition and need for possible enzyme replacement), and signs of dumping syndrome.

During the following reassessment, the patient remained NPO x 4 days. IV fluids were discontinued. He was allowed ice chips. His GI tract is beginning to show signs of proper functioning and minimal JP drainage. Very minimal amylase was tested positive in the drainage content. I continued to make the same recommendations.