Wednesday, 6 March 2013

NPO

Everyone who has ever worked at a hospital knows what "NPO" means.  And if your doctor has ever starved you, you found out the hard way that NPO is Latin for "nil per os", or "nothing by mouth".  That means you get nothing to eat, nothing to drink, nothing except IV fluids.  There are several reasons why you might be kept NPO -

  • You are about to have surgery - it's important for the anaesthesiologist for your stomach to be empty when you are put to sleep
  • You have an infection in your abdomen
  • You have an obstruction in your intestines
  • Your intestines aren't functioning properly
  • Your surgeon hates you
Ok, that last one is a joke...mostly.  We never keep food out of your mouth if we can help it.  Believe it or not, we do actually enjoy seeing our patients get better, and good nutrition is always part of that recuperation.  But unfortunately there are those rare times when we need you not to eat or drink, and that's where NPO comes in.  Most people are understanding and follow the plan despite how difficult it is.  But others...well, let's just say that hunger and thirst can drive people to improvise.

I admitted a man in his 50's with what appeared to be a bowel obstruction. This is most commonly caused by scar tissue in the abdomen from prior surgery, and the usual treatment for it is IV fluids, inserting a tube through the nose into the stomach to decompress the GI tract, and the dreaded NPO, and the obstruction usually goes away by itself.  We did exactly this for this man, but he immediately pulled the tube out of his nose.  The nurse reinserted it, and he immediately pulled it out again.  This cycle repeated itself several times, and he continued to be generally uncooperative and obnoxious.  Finally I realised that I wasn't going to win this battle, so I decided to keep the tube out, but the NPO order stood.  Despite my orders he kept asking for something to eat or drink, and I told him repeatedly that he couldn't.

When I came to see him the next day, he had taken matters into his own hands. Overnight he took his IV bag down, unplugged the IV tubing from it, and had poured his bag of saline into a cup so he could drink it.

Yes, seriously.

Sometimes people get better despite their own best efforts to derail the process, rather than because of our best efforts to make them better.  Luckily this guy got better and went home a few days later.

I made sure the nurse gave him a cup of coffee on his way out so he didn't try licking a puddle in the parking lot.

4 comments:

  1. Wow really? I spent the month of November sitting beside my sister to bat her hands down. It didn't help that she would reach the surgeon's role and he would extend the expectations. I finally told him to give me a real deadline or I would rip that thing out myself and buy her a happy meal. She was eating a few hours later. She did fine.

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  2. Ha! Just had a patient the other night who was NPO with an NG tube with a SBO. He "fired" the RN and me (the patient care tech) for not letting him have more than one cup of ice per shift. He called us bitches and wenches. All I could do was say sorry and throw my hands in the air.

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  3. It's hard to be on NPO, I swear that when I have been prepping for my surgeries, every commercial was about food! Lol

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  4. I guess I'm the 75% obedient patient (25% bastard patient from hell too...), anyway, about three years ago, I was NPO because of an exploded appendix (not just ruptured, exploded and I have the 12.5 cm (5 inches for US based readers) bellybutton midline scar to prove it) so I had the nasogastric tube for 6 or 7 days (9 days stay after surgery). At first, I didn't mind but after that so many days, I wanted it out and they told me I needed to pee once or twice on my own in the bathroom. Same deal with food. Unfortunately, I was dealing with obstructed bowel because no one told me I needed to take a walk from time to time on the surgical aisle (I ran the marathon right after having being told this minor detail).

    Regarding the bowel issue, the surgical team ensured I used adequate pain control (the microdose pump, I could use it every 5 minutes but right after surgery, every 10 to 15 minutes was adequate for pain control).

    Oh well ;)

    Al


    footnote: this is relevant to my pain tolerance: https://www.ncbi.nlm.nih.gov/pubmed/19707566

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