Npo and medication

[igotsdamunchees]

Might be a dumb question...but if a patient is NPO at midnight for capsule endoscopy at 8A, is admitted to the hospital with hepatic encephalopathy, and has lactulose scheduled at 2A and 6A, would you hold it or give it?

[annie.rn]

Interesting question. I'm not sure of the answer so I am looking forward to the responses.

Maybe post in the G.I. forum as well for best responses?

I know the lactulose is to lower the ammonia level but it also makes you poop so I'm undecided. Is the pt. showing signs of hepatic encephalopathy? If they are, I would lean toward giving it.

On the other hand, it seems like it might make the capsule get expelled more quickly and therefore not get ideal results.

If pt. not actively confused, my gut says (see what I did there...gut? Ha, ha!) hold it until you can ask the GI guys/gals in the A.M. Two doses shouldn't hurt anything.

Sorry for not settling it for you.

[nursephillyphil, BSN, RN]

that would be a good time to clarify with the md, at my facility we have "strict npo" and "npo except meds"

[TheCommuter, BSN, RN]

At my workplace, the vast majority of the physicians clarify in their orders to make the patient "NPO after midnight; may administer a.m. medications p.o. with small sips of water as needed."

[Rose_Queen, BSN, MSN, RN]

I would definitely clarify the order. My cardiac surgeons have a preop order set that includes "NPO except cardiac meds with sip of water". Can't get any clearer than that. Some medications are absolutely necessary.

[Karou]

You would have to call the GI and clarify the order. Explain the dx, the medication, and ask if the doctor wants it held or given.

In my experience, on a med surg floor with a lot of GI patients, the doctor will have is give it if it's Lactulose. I still always call and clarify though because the last thing the patient needs is a cancelled procedure due to not being strictly NPO.

[NurseStorm, BSN, RN]

I'm thinking the lactulose possibly may be given as a bit of a prep for the capsule endoscopy? Unless it is regularly scheduled at 2am and 6am which is very strange.. But yes you should clarify. Just wanted to throw this option in, because as someone who had a capsule endoscopy in the past, I had to be NPO after a certain time, EXCEPT I then had to drink a certain amount of bowel prep at a certain time to push any remaining "stuff" out of the small intestines.

[melizerd, ASN, RN]

Another one who has most doctors place orders that say NPO except meds, or strict NPO.

[turtlesRcool]

Like with just about everything else, when in doubt concerning an order, ask the doctor.

[NurseKatie08, MSN]

Actually, not at all a strange order coming from the perspective of a pre & post transplant nurse. If our liver failure patients are admitted acutely encephalopathic and are able to take PO meds, we often have to give them Lactulose as frequently as q2 hour or even in enema form until their MS clears. It can be a messy situation. Your thoughts make sense, but as this patient had hepatic encephalopathy, I suspect they needed the Lactulose q4 to maintain mental clarity. It is a delicate dance of being sure we are not totally depleting their lytes with all the BMs to being sure they are no longer altered. Only way to fix encephalopathy is with lactulose (and then treating the underlying cause, often an infection such as SBP or a UTI, medication non compliance, constipation or dehydration).

I'm thinking the lactulose possibly may be given as a bit of a prep for the capsule endoscopy? Unless it is regularly scheduled at 2am and 6am which is very strange.. But yes you should clarify. Just wanted to throw this option in, because as someone who had a capsule endoscopy in the past, I had to be NPO after a certain time, EXCEPT I then had to drink a certain amount of bowel prep at a certain time to push any remaining "stuff" out of the small intestines.