A client recovering from acute pancreatitis that has been NPO (nothing per mouth) asks a nurse when he can begin eating again. Which response by the nurse is most accurate? 1. “As soon as you start to feel hungry you can begin eating.” 2. “When you have active bowel sounds and you are passing flatus.” 3. “When your pain is controlled and your serum lipase level has decreased.” 4. “Oral intake stimulates the pancreas so you will need to be NPO for at least 2 weeks from the day your disease was diagnosed to allow the pancreas to heal.”
The correct answer and explanation is:
The correct answer is:
2. “When you have active bowel sounds and you are passing flatus.”
Explanation:
Acute pancreatitis is an inflammatory condition of the pancreas that can cause severe abdominal pain, nausea, vomiting, and systemic complications. In the initial phase, patients are typically kept NPO (nothing by mouth) to rest the pancreas and prevent further stimulation of digestive enzyme secretion, which could worsen inflammation.
Criteria for Resuming Oral Intake:
Before resuming oral intake, the healthcare team evaluates multiple factors:
- Return of Gastrointestinal (GI) Function:
- The presence of active bowel sounds and passing of flatus indicates that the gastrointestinal system is recovering from the inflammatory response.
- These signs suggest that peristalsis has returned, reducing the risk of ileus or complications like nausea and vomiting upon reintroducing food.
- Mild Symptoms or Symptom Resolution:
- The patient should have minimal to no abdominal pain and should not experience nausea or vomiting before progressing to an oral diet.
- Gradual Reintroduction of Food:
- Initially, a clear liquid diet is introduced, followed by a low-fat, easily digestible diet to prevent overstimulating the pancreas.
Why the Other Answers Are Incorrect:
- “As soon as you start to feel hungry you can begin eating.”
- Feeling hungry does not necessarily mean the digestive system is ready for food. The pancreas must be rested adequately, and GI function must return.
- “When your pain is controlled and your serum lipase level has decreased.”
- While these factors are important, they do not necessarily indicate readiness for food. Serum lipase can remain elevated for days, even after symptoms improve.
- “Oral intake stimulates the pancreas, so you will need to be NPO for at least 2 weeks.”
- Prolonged fasting is not always necessary. Early reintroduction of food (once bowel function returns) is preferred to prevent malnutrition.