I was written up and put back on orientation

Nurses Safety

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I am an rn at a small rural hospital 4 months in. I had a pediatric post op ruptured appendectomy patient. He was npo about 5 hrs of having him his bowel tones returned so I let him have ice chips he handled that well so I let him have a few sips of apple juice about 2 hourd after tje ice I did not call his doctor to okay this and I have been reprimanded and put back on orientation if I have any more mistakes or complaints from docs or coworkers in the next 30 days I will be terminated. I thought this was what I was supposed to do.

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Do you call the doc at midnight to ask if you can advance to ice chips?

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Specializes in Complex pedi to LTC/SA & now a manager.

Yes if the order was NPO or NPO but ice chips. If the order wasn't NPO until +BS the advance diet as tol beginning with ice chips to clear liquids, then you need to call to request an updated order & MD approval especially if a ruptured appendix with risk for peritonitis. I've had non emergent abdominal surgery and it was ice chips upon return of BS and OOB as tol with IV fluids until surgeon assessed in AM.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Welcome to AN! The largest online nursing community!

If the order was NPO he is NPO until further orders. This kid has stool in his gut from the ruptured appendix and can still sour. The patient cannot have anything by mouth unless the order read may have ice chips and advance to clear liq's after onset of bowel sounds. Just because you see other nurses do things it is not wise to follow suit.

Was the child obsessing about having ice chips? Was the parent driving you nuts? If so....yes, I would call for an order. I'd rather get yelled at for calling about something stupid so I can look the parent in the eye and state "I just spoke with the MD and he said no! so the answer is NO!"

My conversation would be this...."Hello Dr. this is Esme from second floor I am calling about Joey Smith the fresh perf appy 2 days post op in room 5. I'm sorry....I know this isn't going to make you happy but the mother is driving me nuts...I have explained that Joey is NPO however she is demanding Joey to have ice chips"...now the MD may spew profanities demand your name and call you incompetent...but when the mother complains to the ADMIN on a satisfaction survey you have back up that you tried to give her what she wanted.

Try not be let this get you down....everything is a learning curve...but you need to be extra careful

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Do you call the doc at midnight to ask if you can advance to ice chips?

My question is why was this not addressed on another shift? It is frustrating when other shifts don't think ahead. Or was there a reason the MD wanted this kid to remain NPO for an extended period of time? What made the subject of ICE chips come up?

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Specializes in Cath/EP lab, CCU, Cardiac stepdown.

You can implement the advance in dietary changes but you need an order first. If you assessed and the patient seems ready for the next step, you call the dr. And say so and so appears to be doing better based on my assessment of blah blah blah, is it alright for us to advance his diet?

You can't just decide to advance his diet without consulting the doctor first. Even if it's late you gotta do what you gotta do to advocate for the patient. Remember it is best to be safe rather than sorry especially when you're new. Good luck!

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Specializes in ICU.

I've never worked in peds, but I imagine that the parents are probably at bedside and concerned when their child could have something to eat or drink. Since the orders are written as NPO without any "advanced as tolerated" orders, I would of kept to the NPO status. I would, however, swab the inside of their mouth with those pink sponges to keep their mouth from feeling soo dry. Swabbing is okay when a pt is NPO until it can be addressed in the morning.

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Specializes in Complex pedi to LTC/SA & now a manager.

If the order is NPO and the parent and child are not upset about it, leave until am or perhaps offer oral swabs. It is NOT within nursing judgement/scope to advance diet without physician order.

If you advanced to ice chips & apple juice without an MD order ( especially in a post op perforated appendix child) you were wrong and could have caused significant harm to this child. You might have gotten a verbal for ice chips but advancing to apple juice without a physician order went too far. Either say no or call the MD. (Even if overnight shift, I'm sure the MD would rather get your assessment and request in the middle of the night rather than risk patient safety).

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Thanks for the responses, wow I may not be ready for this job. I have no confidence in myself or my so called skills.

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Thanks for the responses, wow I may not be ready for this job. I have no confidence in myself or my so called skills.

Use this to learn from but don't give up. Even long time nurses make mistakes. It sound like you were trying to help. Please just ask one of the other nurses if you are not sure, hopefully you have at least one there that is good and will help.

None of us knows everything and the day that we think we do is the day we need to get out of this field. Just ask questions or use reference materials to check. But don't give up. You can do this! ?

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My question is why was this not addressed on another shift? It is frustrating when other shifts don't think ahead. Or was there a reason the MD wanted this kid to remain NPO for an extended period of time? What made the subject of ICE chips come up?

I don't know how long they wanted him npo or why it may have been a long period of time. The orders were very brief and did not include much info. I definitely should have called the doc to clarify orders and ask about the npo. My great big mistake and I didn't even realize how big of a mistake it was until everyone has shed light on it for me. Thank God no harm came to the patient.

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Thank you

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