Nursing management of patients who are nil by mouth

Headnote

Summary

This article examines how to manage patients who are nil by mouth (NBM) and maintain optimal nutritional status. Pre-operative fasting and other reasons why patients might be NBM, methods of administering nutritional support and nursing considerations, such as mouth care, urine output, intravenous therapy and skin assessment are also discussed. The article provides an insight into the psychological effects on patients who are NBM and emphasises the importance of patient education.

Keywords

Enteral and parenteral nutrition; Fasting; Pre-operative fasting; Pre- and post-operative care

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PATIENTS MIGHT BE designated nil by mouth (NBM) for a variety of reasons and for varying lengths of time. Some patients can be kept NBM for a relatively short time before undergoing anaesthesia, while others may undergo a NBM status for longer periods, for example, severely impaired pharyngeal clearance following a cerebrovascular accident (CVA). Patients might have had surgery or radiotherapy to the head or neck, have carcinoma of the head or neck area, have a fistula of the oral cavity or oesophagus, have a non-functioning or inaccessible gastrointestinal (GI) tract as a result of a bowel obstruction, toxicity or have undergone major abdominal surgery (Aylott et al 2004). The nursing management of patients who are NBM is important to ensure that the individual is not exposed to the damaging physiological and psychological effects of prolonged fasting.

This article aims to examine some of the reasons why a patient may be kept NBM and draws on the nursing assessment and management of such patients. In addition to physiological monitoring the article emphasises the importance of the psychological preparation and management of patients before and during the NBM period.

Reasons for keeping patients nil by mouth

Patients are commonly kept NBM before undergoing anaesthesia, however, there are a number of other common reasons.

Dysphagia This can be defined as an abnormality in swallowing and occurs in approximately 45% of patients admitted to hospital with a CVA (Royal College of Physicians 2004). Dysphagia causes problems...