Right after a duramorph C/S many of our L/D RNs feed the pt. Apple Juice and soda or graham crackers often with Percocts-I was taught that ice chips for the first 12 hours (IN some hospitals-24 hours) would avoid N/V as well as being told since abdominal surgery causes the bowels to slow or stop r/t manipulation, the stomach may not empty for 12-24 hours. Also we don't usually go beyond clear liquids until flatus, but some doctors order Regular diet immediately. What do other hospitals do?
May 18, '03
When I went from Med-surg to post-partum nursing, I could not believe that some of the OB's would allow pts to start on a regular diet immediately after the c-section. However, I found a research article in the journal Obstetrics & Gynecology that seems to indicate that most patients will not have any problems starting a regular diet 2 hours post c-section and may even have a return of normal bowel function sooner. (Of course, this is for epidural patients and not general anesthesia surgery patients.)
If this works, here is a link to the article...
The article indicates that the length of surgery had more to do with developing a post-op ileus than what or when the diet was advanced after the c-section.
Last edit by indynurse on May 18, '03
May 20, '03
white robin that is the old way of doing things
new studies show faster recovery with short hospital stays and decreased incidence of illeus with rapid advancement of diet.
or hospital the general rule is ice chips and water at first if tolerated well minutes to one hour juices and clear liguids. full liguids with in 12 hours regular diet in 18 to 24 hours. I avoid carbonated beverages it seems to create more gas problems.hope this helps
May 21, '03
We start with ice chips immediately after return from OR, if she is up to it, moving on to clear liquids and crackers. If tolerating well and NO N/V, she may have a soft diet her next meal. OF COURSE IN ENCOURAGING EATING, you MUST make SURE the patient is ambulating EARLY on. I help them out of bed within 6-8 hours after surgery unless their legs are not "with them" yet...certainly within 12 hours, they need to be walking up to the chair in the room and to the bathroom for pericare, unless there is a specific condition preventing this. The sooner and more they walk, the more quickly and completely they recover from csection. I know, I had one myself, in addition to being an L and D nurse.
May 23, '03
Duramorph is the devil! It seems like everyone reacts to it with either N/V or really evil itching.
May 24, '03
I LOVE Duramorph! I have been doing this long enough to have gone through the IM Demerol q4hr days (talk about pin-cushion butt), then the PCA days, neither of which can hold a candle to Duramorph for pain control and early ambulation. Getting Duramorph pts moving is a BREEZE compared to trying to get the PCA-ers out of bed and walking. Yes, some of my pts have problems with itching, but it is not usually that bad.
Now...... what was this thread about? OH YES, C/S diets. With early ambulation it seems that pts can tolerate advancing their diet faster, as some have said. And although I have only seen one ileus in 15 yrs in OB, I still think we should be a BIT cautious. On my floor I believe our standing orders are "Adv as tol", which to some nurses on my floor means giving a pt a regular dinner tray as soon as they're done with recovery! I don't think we are doing pts any favors by feeding them full meals when they have no bowel sounds.
May 24, '03
I had a c/s on Mar 18. I had not eatten for about 36 hours by the time the surgery was done. I was starving! The nurse gave me some juice and I threw it up but I was still starving. I got my husband to order a pizza. The nurses werent happy but didnt stop us. I ate 4 pieces of pepperoni pizza and drank 2 cans of coke 3 hours after the c/s( real healthy, I know) and I felt great. No nausea at all. I am a nurse and should have known better and I was lucky that I didnt get sick but let me tell you, food never tasted so good! And the duramorph did make me itch like crazy, especially the tip of my nose but I didnt need anything else for pain and was d/c 48 hours later. Kim
May 26, '03
I hate duramorph, they dont have any better pain control than iv pain meds most of the time. and almost all have itching that is almost impossible to control.
May 26, '03
We have good success w/duramorph spinals. Good pain control for at least 12-18 hours and by then, they get PO meds for pain control along with toradol IM or Motrin. They do wonders with FEW problems, many fewer problems than PCA's cause, by my experience!
May 27, '03
Now there is new literature supporting regular diets post surgery. I just watch the patients and tell them to take it easy...It isn't easy giving up the old ways....
May 27, '03
Mark, you must have a different batch of duramorph than we are using. Ours can have nubain for itching, if they have itching, and that also helps with pain. I see a lot of difference with duramorph and wish it had been available to me with my sections, although, luckily, I didn't think it was too bad to begin with...
May 27, '03
Thank you to all who responded. I think I needed to see the updated research to move forward with what I have already seen, that some pts can tolerate food even before flatus. Knowing that I'm not causing a higher risk for ileus is a relief, now I can advance those patients that seem able to be advanced smoothly earlier, as usually is their request. Kathy RNC
May 27, '03
yeah motherbaby it most be a different batch of duramorph,
I swear it was so bad here for a while they stopped using it all together.
we give nubain and benadryl for itching
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