NPO except for medications

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Hello all.

I wanted to get some insight on how much fluid this entails. If the patient is going for a procedure or surgery, but has an order for NPO except for medications, how much fluid do you give if they have 8-10 tabs of medications to take (60ml, 90ml 100ml?). Do you know of a safe range?  What about crushed meds in applesauce if the pt is on a dysphagia diet. I want to make sure it's a safe amount for the patient. I just want an estimation on what you would give. I know calling the doctor is an answer but the reality is calling every day just is not feasible. Thank you. 

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Specializes in Geriatrics, Dialysis.

Most providers just write the orders to give with "sips" of water. Not real helpful. Some patients will only require a small sip to get the meds down, some may require a  bit more. I've always just given the meds with as little water as that patient requires. A little applesauce is also OK for those that require crushed meds

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kbrn2002 said:

Most providers just write the orders to give with "sips" of water. Not real helpful. Some patients will only require a small sip to get the meds down, some may require a  bit more. I've always just given the meds with as little water as that patient requires. A little applesauce is also OK for those that require crushed meds

Or just give the meds as ordered and communicate with the anesthesiologist/provider the amount that was given if there is doubt. But I think there should be 'don't exceed 30mls, 60mls', etc b/c some ladies can't get the meds down and have to drink cups of water.

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Specializes in oncology.
delrionurse said:

 What about crushed meds in applesauce if the pt is on a dysphagia diet. I want to make sure it's a safe amount for the patient.

A nurse on my floor gave applesauce with meds while the patient was NPO excepts for sips with meds . I was so surprised  I tried to clarify  What is it about "sips with meds you don't understand?" 

Then a student and I took the patient to the Pre anesthesia  area.  I went because I wanted to make sure the anesthesiologist knew  about the applesauce. This hospital doesn't have any pre-op checklists any more. WOW!?

 I made sure to disclose the applesauce as told to me by the floor nurse.   The Anesthesiologist postponed her case for 3 hours.

Where did critical thinking come into this? I don't think the RN  ever understood the repercussions  of her actions. She was fired (not for this) but a total of actions.

Apples sauce is a more of a solid. If the patient cannot take the crushed meds with water at the scheduled time. then give them before they are NPO. Consider if they may have an NG after surgery and what mainstay medications are necessary every day. 

 

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londonflo said:

A nurse on my floor gave applesauce with meds while the patient was NPO excepts for sips with meds . I was so surprised  I tried to clarify  What is it about "sips with meds you don't understand?" 

Then a student and I took the patient to the Pre area.  I went because I wanted to make sure the anesthesiologist knew about about the applesauce. This hospital doesn't have any pre-op checklists any more. WOW!?

 I made sure to disclose the applesauce as told to me by the floor nurse.   The Anesthesiologist postponed her case for 3 hours.

Where did critical thinking come into this? I don't think the RN  ever understood the repercussions  of her actions. She was fired (not for this) but a total of actions.

Apples sauce is a more of a solid. If the patient cannot take the crushed meds with water at the scheduled time. are give them before they are NPO. 

Then the order needs to specify "meds need to be given ONLY with sips of water, otherwise NO MEDS!" These EHR'S and slips in doctor responsibility is getting too much. As if they have NO responsibility in entering orders and no responsibility in the outcome of the patient. 

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delrionurse said:

Then the order needs to specify "meds need to be given ONLY with sips of water, otherwise NO MEDS!" ...

The order was clear: NPO except for medications.  Many are able to take their medications without water.  

delrionurse said:

... These EHR'S and slips in doctor responsibility is getting too much. As if they have NO responsibility in entering orders and no responsibility in the outcome of the patient. 

This is neither related to the EHR nor a "slip in doctor  responsibility."  If the patient is unable to take their medications without water, as the nurse caring for the patient it is your responsibility to raise this to the physician so that he or she can modify the order to allow sips with the medication.  As for volume, while this would best be directed to the anesthesia provider, my thought would be less than 30 mL.

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Specializes in oncology.
delrionurse said:

 NPO except for medications,

 

delrionurse said:

Then the order needs to specify "meds need to be given ONLY with sips of water, otherwise NO MEDS!"

 Did you have a lecture on pre surgery, I am assuming you covered the horrible effects that food (applesauce) in the stomach can be aspirated when the patient is intubated in your nursing education. 

And you would covered surgery itself, and postop surgery .

Nursing wants to be considered a profession, but then we have to show critical thinking in our activities. , 

If you can't stand the heat of critical thinking (wanting everything to spelled out for you)... for example

 A)"Only walk the patient if they are not dizzy

B) "only do I & O if they are NPO with fluids"

C) If they have a tracheal stoma, please make sure it is not blocked to air

D) Please do not empty Chest tube Pleural Vac. 

 

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delrionurse said:

Hello all.

I wanted to get some insight on how much fluid this entails. If the patient is going for a procedure or surgery, but has an order for NPO except for medications, how much fluid do you give if they have 8-10 tabs of medications to take (60ml, 90ml 100ml?). Do you know of a safe range?  What about crushed meds in applesauce if the pt is on a dysphagia diet. I want to make sure it's a safe amount for the patient. I just want an estimation on what you would give. I know calling the doctor is an answer but the reality is calling every day just is not feasible. Thank you. 

Think about the rationale for the orders, which is due to relaxation of the esophagus, intubation and potential for nausea later risk of aspiration.

Water, unlike other foods and non-clear drinks being aspirated is not going to cause pneumonia. 

Think also about the fact that just swallowing saliva and the production of stomach acid continues I think around 2 ml per minute enters the the stomach. So whatever it takes within reason should be OK. 

There is a lot of evidence that drinking clear liquids is not harmful 2 hours prior to surgery. In fact being hydrated and having a source of carbohydrate leads to better outcomes (ERAS/Gatorade). This has not changed the practice of ordering NPO after midnight even for surgery scheduled in the afternoon. Maybe someday the orders will become more aligned with evidence. 

I would not give crushed meds and applesauce as that is introducing food. And that is a no go. 

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londonflo said:

 

 Did you have a lecture on pre surgery, I am assuming you covered the horrible effects that food (applesauce) in the stomach can be aspirated when the patient is intubated in your nursing education. 

And you would covered surgery itself, and postop surgery .

Nursing wants to be considered a profession, but then we have to show critical thinking in our activities. , 

If you can't stand the heat of critical thinking (wanting everything to spelled out for you)... for example

 A)"Only walk the patient if they are not dizzy

B) "only do I & O if they are NPO with fluids"

C) If they have a tracheal stoma, please make sure it is not blocked to air

D) Please do not empty Chest tube Pleural Vac. 

 

You have poor examples. 

 

 

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chare said:

This is neither related to the EHR nor a "slip in doctor  responsibility."  

Yes it is ma'am.  But you use the term 'related'. You switched it on me. It is everyone's responsibility to make sure the patient is safe.  

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delrionurse said:

Yes it is ma'am.  But you use the term 'related'. You switched it on me. It is everyone's responsibility to make sure the patient is safe.  

First, I'm not a ma'am.  And yes, it is everyone's responsibility to ensure that the patient is safe.  However, based on the portion of your post I quoted it seemed that you were placing the blame on either the EHR or physician; my apologies if I misread your post.

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chare said:

First, I'm not a ma'am. 

 

I'm not sure what's so upsetting about this. It's just a term. I'm not saying 'b' I am not saying 'id..' I am not saying anything like that. It's not meant to be rude.  People speak like that all the time around my region. 

 

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