Arlyn continues to get better as the day goes on! Guess who got off oxygen today? This morning early on Arlyn was weaned and did beautifully. I was very pleased that her electrolytes continue to stabilize out, Her calcium is better and they cut her supplement in half (100 mg). The big question for Arlyn is what is going to happen with her feeding. She has a ND tube that she has been fed through and tolerated now for days but when fed yesterday by mouth she vomited so today they decided to insert a gastric tube and leave the ND tube in so what ever she doesn't tolerate they can still put down the ND tube so she doesn't suffer any less nutrition. They increased her feeds and she is tolerating them well. Currently her NG tube is going at 5 ml/hr and her ND feed is going at 13ml/hr. The NG will continue to increase by 5ml/hr every 6 hours while the ND feed will decreased by 5ml/hr every 6 hours until she is being completely fed in the stomach. Nutrition, speech and lactation did not stop by today so thinking they may stop tomorrow. The NP talked to me today about how really she is loosing weight and we need to give her time to catch up with weight gain so for now they are not going to try and feed her by mouth. She is still allowed to breast feed but it is considered "play" because she is not expected to get any nutritional value from it, it is just to exhausting to get nutrition this way when you are as far behind as Arlyn is.
Tonight on rounds I plan to bring up reglan, they initiated this for gastric motility and to help her tolerate feeding although now she is having projectile diarrhea more than once today and I feel like the increased bowel movements may be better if they slowed down a little bit to allow for more absorption. The other side of this is causing her to delay her gastric emptying and have problems the other way but hopefully we can find a happy medium. Thank you for all the prayers and support this little girl is at the tail end, love he so much!
No more Oxygen :)
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