NPO and meds

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When a patient is made npo for a procedure, the resident's never address the medications. So nurses will tell the LPN give this, hold that, etc. Is this "nursing judgement" to decide what meds to give and hold? I think if the resident makes someone npo, they need to place an order "npo-meds with sips". I had one nurse tell me that for CT's with contrast, abdominal echos, they will give meds. If they are scheduled for surgery they hold their meds, saying they are strict npo. I always thought the definition of npo was pretty black and white:) I guess what I'm asking is; is it in a nurse's scope of practice to decide what meds to give to a patient who is npo?

One more question for anyone that has worked at both a teaching and a nonteaching hospital. How would you compare the workload/stress of working at each. Being a new grad, having 9 patients, and working with resident's is so stressful for me. It takes up a lot of time to page them, question an order, have them tell you to go through with the order, page the resident's supervisor, you get the picture. I know MD's write questionable orders too, but not every order! (ok maybe not every order, but it sure seems like it!).

Any advice would be appreciated!

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Specializes in MICU, SICU, CICU.

At my facility, the docs will generally write NPO with meds. And generally depending on procedure we will only give the important meds. Such as anti-rejection meds, BP meds, 1/2 dose insulin, and any med that requires a dose to maintain a therapeutic blood level.

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Fortunately, we work with pretty much the same docs all the time on my unit, so we pretty much know what's expected as far as giving meds to NPO patients. It's pretty much the same as Nurseboy1, we give BP meds, steroids if needed, etc. I'll give you a little story though......I once got a transfer from another hospital. This patient was going to have surgery at our hospital and since the other facility knew that, they appropriately kept him NPO. Now, when this man was admitted to their facility, he was actually originally admitted with urgent hypertension and hyperglycemia. So, in addition to witholding food, they also witheld ALL BP meds (because he was NPO) and ALL insulin coverage!! I understand holding the diabetic pills, but sliding scale coverage can still be given! They didn't call the doctor to ask about giving antihypertensives or sliding scale coverage. They could have even obtained an order to give IV antihypertensives if they really wanted to avoid a couple of pills! He came to us with a BP of 240/120, BG in the 300's, and he was miserable. So was his wife, I might add, who had a medical background. I was quite upset, immediately got orders to give him his pills and some IV labetolol to get him under control. If there was a question as to meds and the MD's didn't address it in their NPO orders, PLEASE call them and ask if you're nervous to give any!! I know in a teaching hospital it must be difficult, you don't have the luxury of really knowing your residents and what they expect, I suppose.

Sorry I can't really compare teaching to non-teaching for you. I worked at a teaching hospital a few times for agency, I didn't really like it. I never went back. I think I was just confused as to who to call when I needed an order, etc. and what got to me was the regular staff was just as confused. I LOVED the nurses I worked with, but I don't think they liked the current system either!! LOL I think they just had a bad system there or something. Too hard to say, since I don't know what to expect. Anyway, good luck! :)

P.S. Sorry about the long answer!! I'm too wordy most of the time!! :)

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Specializes in Rehab, Step-down,Tele,Hospice.

Heres a recent NPO story. Had a pt come to me after placement of a g-tube, they held all meds from that day and wanted to hold them at night too so even if I had wanted to give her B/P meds they were unavailable.

Anyway, very long story short she was projectile vomiting when I got to work at 11p that night, turned the feeding tube off, she continued to vomit called the Doc, he didnt seem overly concerned, told me to apply intermittant suction and keep her NPO (duh) so around 1 she starts having seizures, bp is sky high, still puking, and oh yeah 1 half of her face is sliding off!!

Finally after calling the Doc 3 times, convince him to let me send her to the ER (I work rehab) but this is just asinine in my opinion that this had to happen.

I will refuse in the future to take an NPO patient if I can not give their BP meds when needed or at least some catapres, SOMETHING!

I understand them wanting to rest the new tube but they were running her at 55cc/hr on Boost!! This makes NO sense to me. Please more experienced nurses what do you think?

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Thanks for the responses. My main concern is giving the meds without a dr.'s order. Allele, you are right about never knowing what resident is on call!

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Heres a recent NPO story. Had a pt come to me after placement of a g-tube, they held all meds from that day and wanted to hold them at night too so even if I had wanted to give her B/P meds they were unavailable.

Anyway, very long story short she was projectile vomiting when I got to work at 11p that night, turned the feeding tube off, she continued to vomit called the Doc, he didnt seem overly concerned, told me to apply intermittant suction and keep her NPO (duh) so around 1 she starts having seizures, bp is sky high, still puking, and oh yeah 1 half of her face is sliding off!!

Finally after calling the Doc 3 times, convince him to let me send her to the ER (I work rehab) but this is just asinine in my opinion that this had to happen.

I will refuse in the future to take an NPO patient if I can not give their BP meds when needed or at least some catapres, SOMETHING!

I understand them wanting to rest the new tube but they were running her at 55cc/hr on Boost!! This makes NO sense to me. Please more experienced nurses what do you think?

That's terrible!! Nice job being persistant with the doc! I don't understand in todays world why they won't just give the important meds (like BP!) via another route! I think a catapres patch would have been great, barring any contraindications. Or keep them on a monitored unit until po meds are okay. I understand your concern with getting an order, djsrn. If the other nurses are comfortable with just giving the meds, that's no matter. Protect your license and call the doc. Just nice to know you're actually thinking about it and not just skipping the meds b/c the Pt. is NPO! :)

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That's terrible!! Nice job being persistant with the doc! I don't understand in todays world why they won't just give the important meds (like BP!) via another route! I think a catapres patch would have been great, barring any contraindications. Or keep them on a monitored unit until po meds are okay. I understand your concern with getting an order, djsrn. If the other nurses are comfortable with just giving the meds, that's no matter. Protect your license and call the doc. Just nice to know you're actually thinking about it and not just skipping the meds b/c the Pt. is NPO! :)

I'm not sure why 'patch' became a link up there!! LOL :rolleyes:

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I suggest that either you or your nurse mananger contact the anesthesia dept at your facility and get an approved list of what they want given and what drugs that they want held. It will make your life so much easier and you will have documentation covering same.

After working in the OR, as well as Endoscopy, I have found it quite entertaining at times to see what was held and what was given. Best bet is to check with the physician, as witholding certian cardiac meds can have a severe rebound effect and be can be very detrimental to your patient.

I am currently working in a PICU, where most of our intensivists are also anesthesiologists and we rarely hold anything...........

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Specializes in Surgery.

At my facility when a patient is NPO it is the nurse's discretion what to give and what to hold unless the physician specified. I typically give all cardiac, seizure, diabetic, and similarly important meds. My hospital has pretty detailed protocol on diabetic meds so there is never a question as to what to do with those. They also have a policy to never hold any beta blockers for any procedure or surgery. Even if the physician says "hold all meds" we are still to continue those. I'll typically call and remind the physician that the patient is on a beta blocker and it will be continued, per hospital policy. I hold blood thinners, vitamins, probiotics, etc. Then I continue them after the procedure if they are up to it. The blood thinners I will ask the physician to specify when to continue.

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Specializes in LTC/Skilled Care/Rehab.

Generally if a patient is going to surgery the MD will say to hold all meds except for Beta blockers and long acting insulin. When the NPO order is being put in there is a section for NPO except meds or pt may have ice chips. Usually the doctors don't even fill that section out so it is up to the nurse to call in the morning. I generally call the OR to see what meds they want given before surgery.

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Specializes in Cath lab, acute, community.

We use nursing judgement. Ie. If it is anti-epileptics or beta blockers then it is crucial to give. If it is diabetic medication, it depends on their blood sugars and whether it's oral, short, long acting. It seems common sense. The smallest sip of water possible is encouraged.

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