Lab value making NPO detrimental

leslie :-D · Aug 23, 2009

I am going to allow my brain to be lazy and not try to think this through too much. So, at the risk of missing a totally obvious explanation, would you mind explaining why? Don't see polycythemia very often (or at all, yet) so not too familiar. Only thing I can think is that digestion increases metabolic demand, and O2 carried by slow/sluggish blood may actually be inadequate--so, NPO with some IVF could be beneficial?

thanks kanzi, for the vote of confidence.

i may be way off, but i'm thinking that an overabundance of rbc's would affect circulation where pt at increased risk of clots...

whether it resulted in a stroke, mi, pe, dvt...

all have pretty serious implications.

idk how ivf would be beneficial?

if polycythemia becomes symptomatic, the excess cells need to be removed...

adding fluid would only cause further problems, i would think.

leslie

Nurserton · Aug 23, 2009

thanks kanzi, for the vote of confidence.
i may be way off, but i'm thinking that an overabundance of rbc's would affect circulation where pt at increased risk of clots...
whether it resulted in a stroke, mi, pe, dvt...
all have pretty serious implications.
idk how ivf would be beneficial?
if polycythemia becomes symptomatic, the excess cells need to be removed...
adding fluid would only cause further problems, i would think.
leslie

IVF would dilute the RBCs, thereby thinning the blood and decreasing risk of bleeding, stroke, etc. This is common tx for sickle cell pt's also..

I debated b/w the increased RBCs and decreased WBCs combined with the effect of nutrition on healing. I think it really depends on the pts clinical picture. Is the pt already at risk for stroke/bleed, clot, or other cardiovasc issues? Is the pt immunocompromised, septic, fighting off some other serious infection, etc...?

blondy2061h, MSN, RN · Aug 23, 2009

npo doesn't mean no iv and what is procedure?? I would be way more concerned about bowel surgery in a pt with alow whit count than a healthy young lady have an d&c

But they're not talking about surgery. They're just talking about the NPO status.

Whether they're getting IV fluids or TPN or something like that makes a big difference. You could have someone NPO for extended periods of time- way longer than the 8 hrs needed for most surgery- and maintain adequate hydration and even nutrition with the right tools.

I think this question expects the reader to assume way too much.

leslie :-D · Aug 23, 2009

IVF would dilute the RBCs, thereby thinning the blood and decreasing risk of bleeding, stroke, etc. This is common tx for sickle cell pt's also..

i can understanding doing this for sickle cell pts.

but for polycythemia, ivf would only add to the already overloaded volume.

of course i could be wrong (will have to research this:)), but i'd be concerned about fluid overload. :twocents:

leslie

kanzi monkey · Aug 23, 2009

For which (female) pt. would it be more detrimental to their health if they had to be NPO for a procedure?
Someone with a hgb of 9 (norm is 12-16), someone with a RBC of 7 million (norm 4-5.4 million), someone with a hct of 30% (norm 37-47%), or someone with a WBC of 3,000 (norm 5,000-10,000)? Any help or explanations would be much appreciated.

Alright, a bitter rested now. Listening to This American Life, hunting through my pathophys book--I love Sundays off. (Oh, my nerdiness is painful sometimes).

I agree with the poster who says there is not enough info in this question. It is a terrible question, and therefore a good example of what one might come across when taking the NCLEX :banghead:

So, I'll tackle it. I am going to assume that a pt with low hgb has a typical corresponding low hct, and a pt with low hct has a corresponding low hgb (there is no information in the question that leads otherwise, and this is a typical scenario). Since the %hct usually equals approximately 3 x hgb, an hgb of 9 (~hct 27%) and a hct of 30% (~hgb 10) are not different enough clinically (at face value--since we can't assess the pt). So, I will exclude those options.

An RBC of 7 million (polycythemia) in a setting of hemodynamic instability with recent significant changes in fluid status (ie, post op, boluses, blood transfusions, water loss, GI loss, excess diuretics, etc) is relative and can be corrected with increasing fluid volume. Since the question mentions NONE of this, we can assume that the patient is hemodynamically stable, and the polycythemia is absolute-caused by either EPO increase (ie, high altitudes, hypoxia, severe COPD), or by a myeloproliferative disease (polycythemia vera). In polycythemia vera, there is an increase in RBCs, HCT, HGB, platelets, and WBCs. Symptoms include HA, HTN, pain or itching of the fingers/toes, ruddy appearance of lower extremities and other signs of venous stasis, difficulty concentrating, blurred vision, diminished hearing--all r/t slow, sluggish blood flow/venous stasis. There is a high risk of thromboembolism due to increased platelets/slow flow in these patients. THere is also a high risk of hemorrhage due to platelet abnormalities. The treatment is phlebotomy, treatment of underlying disorder (ie, bone marrow suppression, oxygen).

All that said, I can't see how being NPO for a procedure would be detrimental with this condition, either relative or absolute (though if it's relative, they should be replacing vascular volume-either through PO intake or IVF-but there are too many "what ifs" to make this answer fit)

I am left with WBC of 3K. If this is not corresponding to a relative fluid loss (which would include a drop in HCT/Hgb), than this person's immune system is suppressed (though again, the significance of the suppression can really only be assessed by the patient's history and current condition--we don't know if they are neutropenic or pancytopenic, or ANYTHING really, since we don't have the differential). BUT, if they are immunosuppressed, and the gut is being used less, I can buy that the flora of the gut might start to migrate about to avoid the acidic environment--with a compromised immune response, this could lead to an opportunistic infection. I think.

My text is by Porth, 2005.

OP--will you let us know when you learn the answer?

:)

blondy2061h, MSN, RN · Aug 24, 2009

Even with the WBC, we don't know HOW immunosuppressed they are without the ANC. They could be 3k with 94% blasts and be severely immunocompromised, or 3K with a nearly normal ANC and be barely immunocompromised.

Susie Q. · Sep 14, 2009

thanks for all the answers! sorry it took so long to get back to you, but i just got the answer back from my professor. she said that it was the rbc count of 7 million because "this is a high rbc value. if this patient is npo, she may experience a decrease in fluid volume, which would make her blood even more viscous and put her at risk for the development of clots. "

but it's an nclex-style question, so it's probably debatable in real life situations.