E.M. begins coughing and has copious nasal secretions. You provide nasopharyngea
ID: 68700 • Letter: E
Question
E.M. begins coughing and has copious nasal secretions. You provide nasopharyngeal suctioning and obtain a large amount of thick secretions. She is allowed to recover and is reassessed. The respiratory rate and retractions have not changed significantly. Her breath sounds are less coarse but are diminished in the bases. The SaO2 is now 92%-93% on 1.5L oxygen. After E.M. settles, her mother asks whether she can feed her because she has not eaten much for the past few days. You tell her that with a current respiratory rate of greater than 65 breaths/min, she should not be fed.E.M. begins coughing and has copious nasal secretions. You provide nasopharyngeal suctioning and obtain a large amount of thick secretions. She is allowed to recover and is reassessed. The respiratory rate and retractions have not changed significantly. Her breath sounds are less coarse but are diminished in the bases. The SaO2 is now 92%-93% on 1.5L oxygen. After E.M. settles, her mother asks whether she can feed her because she has not eaten much for the past few days. You tell her that with a current respiratory rate of greater than 65 breaths/min, she should not be fed.
4. What is the rationale for the holding the feeds?
5. When E.M's respiratory rate decreases, what teaching would you provide the parents concerning the feeding?
Explanation / Answer
4. Despite the limitations of study design in the literature, holding EN has been shown to improve drug absorption.
in most cases (Table 1). This observation, however, is influenced by publication biases in that mini-trials and case reports with positive outcomes are more likely to be shared by clinicians and researchers and ultimately published in the literature. Regardless, the positive impact of certain clinical approaches for specific drugs in selected patient populations cannot be disputed, provided that certain clinical conditions and procedures are followed. Multiple studies with phenytoin suggest that withholding EN for at least one hour can significantly improve phenytoin absorptio
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