Sepsis

[lilhendy]

Should a sepis patient be NPO or not? I am studying for the PCCN exam and fpund 2 discrepancies: 1 indocates to avoid an NPO status while the other indicated the patient should be NPO. Neither gives the rationale behind either choice. I want to know which is correct AND why.

[VANurse2010]

I would say they need to be NPO because they often become encephalopathic, go into acute respiratory failure, and require intubation - which is safer when the patient is NPO.

[BSNbeauty, BSN, RN]

NPO us safest. If they are hemodynamically unstable we want blood to rush to vital organs. Not the gut.

[MunoRN, RN]

There's ongoing controversy about how risky eating is while on vasopressors, but there's at least a portion of the medical community that agrees patients on vasopressors should not be eating anything significant due to an increased risk of mesenteric ischemia while on vasopressors if the patient is eating.

[firstinfamily, RN]

So what is done for the gut?? Tube feedings etc. How long do you keep someone NPO due to sepsis?? What is happening to their albumin counts?? There needs to be some nutritional supplementation at some point. I understand the need to prevent the potential of complications, but what happens to their nutritonal status?? Are they given TPN until the sepsis is cured??

[jadelpn, LPN, EMT-B]

Coming from the elderly people with UTI's that turn septic in about a moment or two, there can be 2 thought processes that are a bit more simple.

Most of the time, someone who is septic is not fully alert and conscious. They are can be confused. They may not be able to take direction to swallow well. There's a risk of aspiration.

I have also seen some PO antibiotics used for sepsis as well. Mostly with raging UTI's that are JUST this close to sepsis, but in LTC can be attempted to be treated orally first. And to give food can delay the absorption of the PO drug.

Providing that the patient is alert enough to swallow, another thought process is to increase fluid intake orally, as it assists in hydration as well as to assist to clear/flush the antibiotic through the kidneys, which for antibiotics such as levaquin, for one, is not easily cleared by elderly people (or younger people) with poor creatinine clearance.

There's nothing that says you can not advocate for the advancement of a diet when someone is feeling better, doing better...and IV fluid based on need should prevent dehydration for the first stages.

[BSNbeauty, BSN, RN]

I have given albumin. When someone is septic shock feeding them isnt a priority.

[lilhendy]

Thanks everyone. I am studying for the PCCN exam (sepsis) and am still unsure of the correct answer because, in actual practice, most of my peers are not seeing their patients NPO unless they are not conscious or know that they are going to surgery.