how do you decide?

CarVsTree · Feb 24, 2006

I work in trauma so this may be different. But when a postop patient is tolerating (as in no n/v) a clear diet than advance them to regular. That's how it works in trauma and we get some medical patients as well. We NEVER get hysterectomies though. :uhoh21:

lyallch · Feb 24, 2006

I work in trauma so this may be different. But when a postop patient is tolerating (as in no n/v) a clear diet than advance them to regular. That's how it works in trauma and we get some medical patients as well. We NEVER get hysterectomies though. :uhoh21:

I was told by another senior nurse you let them have a light diet once you can hear bowel sounds. I read somewhere auscultating for bowel sounds is not a reliable way of making sure that the bowels are working again. Thank you for your reply. I will keep that in mind.

SouthernLPN2RN, MSN, RN, APRN, NP · Feb 24, 2006

You never really know for sure if the pt will tolerate it, but passing flatus (in my opinion, lol) is a very good indicator that you can advance the diet. She may not have a bm yet because she hasn't eaten "real" food.

NYCRN05 · Feb 24, 2006

Hi Lyallch!

On my unit (postop spines, hips and knees) the only patients who must be npo until they have bowel sounds AND are passing flatus are our spine patients, the doctors INSIST on this. Hips and knees are a little more flexible and as long as they have bowel sounds we start advancing them a from clears to full clears, to soft and finally regular as long as they are tolerating the diet, ie no nausea or vomiting. If at any point they start experiencing nausea or vomiting, it's back to npo.

jenrninmi, MSN, RN · Feb 25, 2006

I work in trauma so this may be different. But when a postop patient is tolerating (as in no n/v) a clear diet than advance them to regular. That's how it works in trauma and we get some medical patients as well. We NEVER get hysterectomies though. :uhoh21:

This is the way we do it too. By the way Sue, congratulations on passing NCLEX! :nurse:

jenrninmi, MSN, RN · Feb 25, 2006

Hi Lyallch!
On my unit (postop spines, hips and knees) the only patients who must be npo until they have bowel sounds AND are passing flatus are our spine patients, the doctors INSIST on this. Hips and knees are a little more flexible and as long as they have bowel sounds we start advancing them a from clears to full clears, to soft and finally regular as long as they are tolerating the diet, ie no nausea or vomiting. If at any point they start experiencing nausea or vomiting, it's back to npo.

When you say spines, are you refering to ACF's and Lami's? If you are, we start with a soft diet and move up from there.

grinnurse, RN · Feb 25, 2006

You never really know for sure if the pt will tolerate it, but passing flatus (in my opinion, lol) is a very good indicator that you can advance the diet. She may not have a bm yet because she hasn't eaten "real" food.

This is how we decide too if the pt's diet will be advanced. Especially if they are passing flatus and have bsx4. All of our hys pts must have a bm b/f being d/c.

NYCRN05 · Feb 25, 2006

When you say spines, are you refering to ACF's and Lami's? If you are, we start with a soft diet and move up from there.

Yes, ACF's, Laminectomies, posterior spinal fusions and decompressions, etc, etc. Like I said the doctors are pretty adamant about npo until +BS and +flatus. Then and only then can we advance them. Do your patients usually tolerate the soft diet right away?

jenrninmi, MSN, RN · Feb 27, 2006

Yes, ACF's, Laminectomies, posterior spinal fusions and decompressions, etc, etc. Like I said the doctors are pretty adamant about npo until +BS and +flatus. Then and only then can we advance them. Do your patients usually tolerate the soft diet right away?

I've never had them not tolerate a soft diet. There have been times they don't want to eat though. Especially with the ACF's or PCF's.