New nurse question re: NPO and meds

[LisaJanae]

Hey...I am a new RN and still on orientation.

I have a question about pts who are NPO for a surgery/procedure/etc and whether or not to give PO meds. I have been orienting with different nurses and I get a different answer from each one.

I realize some MDs write NPO except meds, but do you give PO meds if the pt is NPO with a small sip of water?

Please enlighten this newbe!

THANKS!

[CaLLaCoDe, BSN, RN]

Just the day before yesterday I had a patient status post GI surgery who was NPO, period. Later in my shift I'd forgotten about the NPO status when I noticed that her K+ level was 3.4 ; So, I remembered that she had a PIV and didn't want to cause her a lot of pain with IV infusion, besides PO is the quickest route.

Thank goodness the family members gave me the oddest looks when I attempted to cover the K+ orally. "You know, nurse, she's NPO!" LOL!

[meownsmile, BSN, RN]

If the patient is NPO there shouldnt be anything given. If the doctor or anesthesiologist want certain meds given they will usually write for those to be given and what time to give them with how much water they want them given with. If the patient has a late procedure and has been made NPO after midnight then i suggest calling the anesthesiologist and ask if he would like blood pressure meds given. It never hurts to call and clear up those questions. Better to do it their way than make the wrong guess and maybe have to delay any surgery scheduled.

[catlvr]

How about sublingual nitroglycerin? This was a question on my boards last week, and I was really stumped (passed anyway!).

Thanks, e

[purple_rose_3]

If the patient is NPO there shouldnt be anything given. If the doctor or anesthesiologist want certain meds given they will usually write for those to be given and what time to give them with how much water they want them given with.

In the perfect world yes, that is what would happen. In my experience they just forget about these little things. My logic is, if you call them enough for clarification they will start to remember.

[CaLLaCoDe, BSN, RN]

If the patient is NPO there shouldnt be anything given. If the doctor or anesthesiologist want certain meds given they will usually write for those to be given and what time to give them with how much water they want them given with. If the patient has a late procedure and has been made NPO after midnight then i suggest calling the anesthesiologist and ask if he would like blood pressure meds given. It never hurts to call and clear up those questions. Better to do it their way than make the wrong guess and maybe have to delay any surgery scheduled.

All the time I've spent in nursing I've never seen an order letting me know how much fluid to give with meds when a patient is NPO...just never seen it! Common sense dictates not to give too much though. If you have PO meds scheduled after midnight and you have an NPO order without the added addendum for the exception of PO meds, call the Doc and get clarification pronto!

How about sublingual nitroglycerin? This was a question on my boards last week, and I was really stumped (passed anyway!).

My thought on this is to not hesitate but to give if your patient has had cardiac issues (recent MI, cardiac enzymes elevated, peripheral vascular disease, diabetes uncontrolled) and is complaining of severe chest pain. Even if you had an NPO order, you want to deter untoward events from happening, period. Now if you had 4mg of IVP morphine, would you give that over nitroglycerin PO?!!!

[pirap]

For me NPO is NPO period. If they are on blood pressure meds I monitor the BP and if/when necessary call the MD to let them know and let them make the decision. For me it's that black and white. I followed the order EXACTLY how it was written..if YOU(the MD) wanted me to give them certain meds you should have written it accordingly. It's not my job to try to interpret your order-it's my job to follow it..you said nothing by mouth and they aren't getting anything by mouth-PERIOD.

[MB37]

I'm just a student, but on my clinical a couple weeks ago my nurse (5 yr exp) encountered that problem. Patient was NPO, and previous meds were ordered PO/IV. MD came to do rounds, and ordered new meds, all PO only. My nurse called, he clarified (give with small sip of water, call back if he can't get it down). He didn't belittle her for the phone call.

[billsnurse]

pirap,

I like your approach, it seems simple and easy to follow for everyone. I am not calling the doc unless I have too..(high BP)... I have too many other things to do than remind someone of something. LOL

[brissie]

I betcha your unit has a policy and procedure manual and it might be in there.

[GabrielasMadre]

Always cover your you know what....If you feel the patient may need one or all of his/her meds ask the physician prior to giving the med. If he/she gets upset or rude who cares. If you give the meds and something happens to the patient and you end up in court; no one will have your back because NPO means Nothing by mouth. Alway cover your butt and document, document, document.

[RNperdiem, RN]

This is where a text page to the doc about any meds you question with an npo helps. I find for minor matters, a text page works best. Don't forget to hold the NPH insulin on any patient who will be npo; ask me how I know.