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Operating Room Setup and Positioning
Published in Marc A. Levitt, Pediatric Colorectal Surgery, 2023
The oral antibiotics Neomycin and Erythromycin are given 1, 2, and 4 hours after stool output is clear and Golytely is complete. The patient is made NPO (nil per os) at midnight the night before surgery but clear liquids can be continued until 2 hours before surgery (Figure 28.9). Remember to stop the oral preparation in time for the anesthetic NPO requirement.
Better System Performance
Published in Paul Batalden, Tina Foster, Sustainably Improving Health Care, 2022
Mark E. Splaine, Jeremiah R. Brown, Craig N. Melin, Rosalind A. Lasky, Tina Foster, Paul Batalden
In 2009, the Northern New England Cardiovascular Disease Study Group adopted a goal of reducing the incidence of contrast nephropathy among its 10 participating centers.10 A key component of this effort was understanding the fivefold variation in incidence across these centers, ranging from a low of 1.9% to a high of 10.1%. Site visits, structured focus groups and local process exploration was undertaken. These revealed marked differences between centers that had a uniform approach to prevention (mandatory protocols and use of prophylactic measures) compared with those that had a nonuniform approach (case-by-case model for prevention). The two centers with a uniform approach led the region with the lowest rates of contrast nephropathy. Both had developed and reliably used mandatory protocols to manage blood volume and to limit the duration of nil per os orders, allowing better patient self-hydration at home prior to the procedure. The remaining eight centers with a nonuniform approach had wide variation in the use of prophylactic measures such as circulating blood volume expansion. In contrast to the centers with lower rates of nephropathy, these centers more commonly restricted fluid intake prior to the procedure for a longer period of time (from 10 p.m. or midnight the night before) resulting in a higher likelihood that patients were volume depleted when they presented for the procedure. The full comparison of centers, data, and appendices can be viewed online.11
A patient with severe constipation and a behavioral disorder
Published in Onnalisa Nash, Julie M. Choueiki, Marc A. Levitt, Fecal Incontinence and Constipation in Children, 2019
Katrina Hall, Charae Keys, Rose Lucey Schroedl
Postoperatively, the patient returned to the inpatient unit with a peripherally inserted central catheter (PICC) Foley, epidural for pain management, and nasogastric tube to suction. The patient's bowel function returned after 1 week. The patient's nil per os (NPO) status interrupted a normal routine, as the patient was unable to take their behavioral medications by mouth. The patient was in the hospital for a total of 22 days.
Longitudinal analysis of electrolyte prolife in intensive care COVID-19 patients
Published in Egyptian Journal of Anaesthesia, 2023
Mohammed F. Abosamak, Ivan Szergyuk, Maria Helena Santos de Oliveira, Sara Mathkar Almutairi, Jawza Salem Alharbi, Stefanie W. Benoit, Giuseppe Lippi, Marianna Tovt-Korshynska, Brandon Michael Henry
In this retrospective observational study, adult patients presenting to the ICU with reverse transcriptase polymerase chain reaction (RT-PCR) confirmed SARS-CoV-2 infection, during the period 8th of June 2020 till 18th of August 2020 were enrolled. Besides routine maintenance intravenous fluids, patients with electrolytes deficiency were supplemented with specific electrolyte solutions (e.g., KCl) per physician discretion. The fluid of choice for most patients was normal saline (NS). Patients with NPO (Nil Per Os) status were administered 5% dextrose in normal saline (D5NS), while those with hypernatremia were administered ½NS or D5½NS. Total parenteral nutrition (TPN) was not administered to any patient. Renal patients received Osmolyte or Nepro as enteral nutrition, while diabetic patients were fed Glucerna. An antiviral medication, Favipiravir, was given routinely to all patients, and no impact on electrolytes was observed.
Assessment of knowledge, attitude and practice of nurses regarding enteral nutrition at a military hospital
Published in South African Journal of Clinical Nutrition, 2023
Londolani Ramuada, Lizl Veldsman, Nedzingahe Livhuwani, Renée Blaauw
Factors contributing to worsening nutritional status during hospitalisation include the patient’s primary diagnosis (e.g. cancer), loss of appetite, increased nutritional requirements, and immobility resulting in a loss of lean body mass.7 In addition are nil per os status, and interruptions to feeding due to medical and surgical procedures.8 The lack of nutritional screening on hospital admission, unavailability of feeding protocols and the limited number of nutritionist/dietitian posts available at healthcare facilities may further contribute to the development and worsening of hospital malnutrition.2,9 The impact of malnutrition is associated with a longer hospital stay, increased risk for acquired hospital infection, poor prognosis and increased mortality.4
Intraoperative presentation of an undiagnosed tracheoesophageal fistula in an adult without history of abdominal or thoracic surgery
Published in Baylor University Medical Center Proceedings, 2023
Jim Z. Sheng, Christopher B. Adcock, James D. Haddad, Samuel H. Dunn, Enas Kandil, Tarek Sawas
A 41-year-old woman with type 2 diabetes, end-stage renal disease on dialysis, and necrotizing soft tissue infection of her foot that extended to her groin presented to the operating room for irrigation and debridement of her left lower extremity and sacral wound. She had been on supplemental tube feeds via a Dobhoff tube due to poor oral intake and malnutrition. In the operating room, she was noted to have a mild nonproductive cough but otherwise normal lung exam and x-ray findings. She had pulse oximetry readings of 100% while breathing air. Due to delays in the operating room schedule, she had been made nil per os for over 24 hours before surgery, including tube feeds. The case began uneventfully with intravenous induction and intubation with a 6.5 mm endotracheal tube (ETT) via direct laryngoscopy without difficulty. Halfway through the case, the patient was turned from supine to right lateral position to access her sacral eschar.