What to do with medications if patient is NPO

[JTLewis93]

1. The patient is a 52 year old female with diabetes mellitus type 1. She is NPO because she is scheduled to have an abdominal CT this am. The following medications are due at 8:00am and her CT scan is at 11:00am. What should the nurse do about these medications and why?
   

• Insulin NPH 30 units subcutaneous
  
• Prevacid 30mg PO once daily
  
• Novolog (aspart) insulin on a sliding scale according to glucose levels.
  

During clinical we usually give the medications unless the doctor specifically says to hold them...or we call the doctor when we are unsure. Figured I'd ask you all just to make sure what usually SHOULD be done. I appreciate the help!

[MendedHeart]

Is the SSI ordered AC/HS?

Usually MDs will right NPO except meds most of time but the Prevacid can wait til the test is done because its daily

[akulahawkRN, ADN, RN, EMT-P]

The insulin sliding scale, from what I've seen, has two scales. One for the usual diet and one for when the patient is NPO. For that, follow the written orders. Daily meds can usually wait until after the test precisely because they're daily. Other meds may require that you get clarification from the physician, or check your facility's policies about this. They should have one!

[MendedHeart]

If the SSI is based off of an achs glucose lev then you are covered there, you wont have to give that but the NPH should have orders to hold or give 1/2dose based on blood sugar. But you definitely need an order to hold it.

[Esme12, ASN, BSN, RN]

Sliding scale is usually given according to capillary glucose. Other meds that are not IV held. A call to the MD to clarify would be OK.

[libby11]

Prevacid can usually be held. Facility likely has a policy or standing order on the unit for holding insulin/what scale to use when client is NPO. If no policy or standing order, hold (depending on client's current BS) and call Physician for clarification.

[classicdame, MSN, EdD]

hold everything. Check glucose levels periodically if patient has been NPO >8 hours to prevent hypoglycemia.

[psu_213, BSN, RN]

If the order is written "NPO," they cannot have their pills. Usually the doc will write "NPO except meds" if indeed they do want the pt to have the meds.

As for their sliding scale insulin...it is based on a CBG reading, but it is also based on the understanding that the pt is going to consume carbohydrates. I would want an order from the doc one way or the other on whether or not I should give this insulin.

The NPH insulin...what is it purpose? What is its onset, it duration of action? This should give you some guidance about whether it should be held or given.

[krisiepoo]

I'd like to add that the pharmacy can be very helpful in situations like this as well. A couple hospitals I had clinicals in there were pharmacists available (one even had his own station on the unit) and if I had a med question I could go ask them. They are a wealth of knowledge