Pt had an EGD in the AM and he was NPO. He had a J-tube and got all his meds through there. It was 4am and I held 3 meds, it was medication for depression, muscle relaxer, and one for neuralgia. I thought that since these weren't critical meds like cardiac meds and since he was getting an EGD, his stomach should be empty. Meds via the J-tube would require flushing the tubing with water. I thought what I did would be ok. Then he can get his dose when he comes back. The nurse that had him after me said that I should have given him his meds. Was that wrong of me?
Thanks for you help.
Dec 8, '12
This is something that should have been clarified by the physician if there were no orders regarding medications while NPO. Depending on the meds, maintaining a schedule can be critical to ensure a therapeutic level in certain medical conditions.
Dec 8, '12
I know there is a huge issue with terminology when it comes to tubes so let me ask where the J-tube was. J-tubes that I have worked with are not in the stomach, they are in the small intestine. PP is correct, this is something that should have been clarified with the MD.
Dec 9, '12
Yeah.....J tube goes into the small intestine. If I had to decide with out easily contacting the doctor I would hold those pills. As you said they were not critical.
Perhaps the nurse was correct, perhaps she has dealt specifically with this doctor or this issue before. But few nurses would be so certain as she seems to be.
Don't let this nurse make you feel dumb or that you should know all about J-tubes, holding pills, etc. I have dabbled in GI nursing for years.....have worked in a variety of different areas of nursing...... but still I would have been just as confused as you and I would have held the pills.
The longer I work....the older I get....the more I say "I don't know....." and find experienced co-workers saying "I don't know either." Don't assume another nurse knows all the answers, ask for her rationale or to see the policy, or ask the GI doctor when you get a chance.
Honestly I can easily imagine asking 5 different GI doctors this question and getting 8 different answers or rationals for why or why not!
Dec 9, '12
If the patient was NPO I would have held them as well. Although this doesn't apply to you at all, I have found nurses chart against IV meds because of NPO simply because they were too lazy to do them. Ugh. That is ridiculous.
Dec 10, '12
Everyone has great points! The patient came in for a upper GIB. And you guys are right, it was a J tube so the stomach would have been empty. I work noc shift and it wouldn't have hurted for me to call the on-call doc to see if I should hold the meds. I didn't think it was that big of a deal though to call the doc in the middle of the night about a muscle relaxer and antidepressant, I would feel silly. Unless it was like antiarrythmics or antiseizure meds (etc.) I definitely would have called.
To brownbook, thanks for your response. The nurse had actually sent me an email telling me I should have given these meds because I was off. So I felt like, "OMG I did something wrong!" And I kept thinking about it and I did feel dumb. But you're right, different docs would've told me different things. Like I said, if I did call the MD, it would have been an on-call dr not the actual doc that was seeing the pt.
Dec 10, '12
She sent you an email, that's a little much. The order should have been clarified when it was written not at 4am like you said. It was safest to hold. My point was at 4am the meds would not have hurt because they don't go "in the stomach" so that would have been my rational for giving. If they were due later around 7-8 or the time of the EDG, I would have held til after. Don't stress over this, we all question when to hold, what to hold and whom to call
Night shift is tough for that reason, we don't always get the MD we need at wee hours of the morning.
Dec 10, '12
Um, just wanted to point out that stomach is not the only thing visualized in an EGD. The small intestine (duodenum) is viewed too. I'm having an EGD next week and they want me completely NPO after midnight, no pills. OP, I would have clarified, but as you said the meds were not critical. I would not lose sleep over this one.
Jan 6, '13
The best answer would be to ask the GI doc that will performing the procedure. Each doc have their own preferences wen it comes to meds.
Feb 18, '13
I agree I would have held them.