Contemporary Issues in Adult Nursing: Preoperative Fasting

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Contemporary Issues in Adult Nursing: Preoperative Fasting

Trends in healthcare are continually evolving and changing, these fluctuations can often have massive implications for nursing practice. How we practice as nurses is often dictated by new policy and guidelines which are brought about by the evolving healthcare system. For an issue to be contemporary it has to be occurring in the present and in the sense of nursing it would seem that many issues could be deemed as contemporary due to the ever fluctuating nature of our healthcare service. For the purpose of this assignment I am going to address the issue of pre-operative fasting and the tradition of fasting patients from midnight until surgery the following day. Evidence suggests that this practice is outdated and unnecessary but still the practice occurs on many surgical wards. I aim to explore the reasons why patients are still subjected to unnecessarily long fasting times and how we as nurses can change this outdated practice.

I have chosen to look at this area of contemporary nursing because as a student nurse I have had practice experience in both a surgical ward and in general theatre. I feel that having had experience in both of these settings I would be able to link theory to practice experience.

Fasting patients from midnight before day of surgery has long been a time honoured tradition. The main reason for the Nil by Mouth rule from midnight has been to ensure an empty stomach at time of anaesthesia. If the patient is not fasted, gastric contents could be inhaled by the patient while they are under anaesthetic. Because the contents of the stomach are acidic it is important that regurgitation and inhalation does not occur as this can lead to an inflammatory response within the lungs which can have dire effects for the patient (Tudor, 2006). Although an empty stomach is vital for safe sedation, the time which the patient is fasted for is also of relevance as is the type of foods the patient consumes before surgery. Woodhead & Wicker (2005) state that new fasting guidelines are more humane and evidence based. Guidelines in the UK have been produced by the Royal College of Anaesthetists and they state that at 6 hours before surgery, patients can consume solids and milk, have a light meal but are not allowed to eat meat or fried foods. At 2 hours before surgery, patients can have clear fluids which include black tea or coffee and fruit juices without pulp (Woodhead & Wicker, 2005).

Oshodi (2004), comments upon the effects of excessive fasting on the patient. He concludes that prolonged fasting is not only unpleasant for patients as they often complain of a dry mouth but post operative nausea can be reduced if patients are allowed to drink clear fluids up to 2 hours before surgery. Rowe (2000) emphasises the point further by stating that patients who undergo excessive preoperative fasting can experience hypoglycaemia, ketosis, hypovalaemia, confusion and headaches. It could be argued that by allowing patients to eat and especially drink up to the recommended fasting times the patient will not only be more comfortable in recovery but the costs of care could be reduced. For instance, the patient's time in recovery would be reduced, as would the patients need for anti-emetics and possibly pain relief.
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The British based Royal College of Anaesthetists recommend the above fasting times however according to Saqr & Chambers (2006) it would seem that these recommendations are still not being followed in the UK. Change of practice has been slow in other countries too. Crenshaw & Winslow (2002) report on a study carried out by the American Society of Anaesthesiology which found that on average surgical patients fasted from solids and liquids for 12 and 14 hours and some patients were found to fast for 20 hours from fluids and 37 hours from solids.

From my own ...

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