I have worked regular Med/Surg for several years, but I am new to working on an intermediate cardiac floor. A couple of nights ago, I got a transfer patient from Med/Surg who was an 89 year old lady with end stage dementia and a hip fracture that had been repaired earlier that day. She came to us because she was severely agitated, yelling, kicking, etc. and had and EKG rhythm of A-flutter with RVR in the 150s. The hospitalist on duty ordered a one time Cardizem IV bolus and then a Cardizem drip. However, once this patient arrived on our floor, she totally quieted down and went to sleep, and her rhythm converted to sinus tach at around 110 with a BP of 90/50 to 80/40. Due to this, I held the Cardizem, both the bolus and the drip. She did fine for a couple of hours and then had another episode like the first one and went into sinus tach in the 150s with a BP of 120/80. I figured that the agitation was caused by post-op pain, so I gave her what was prescribed for pain, Morphine IVP, and she went back down to sinus rhythm in the 80s-90s and a BP of 80/48. She was a DNRCC status, and her HGB came back at 7.3 so I called the doc and got an order to transfuse two units of PRBCs. When I left in the morning, she was quiet and getting the blood, still RSR in the 80s and BP 80/48.
I feel like I probably did the right thing, and that if I had started the Cardizem she would have probably bottomed out, since the 80/40 BP seemed to be her baseline, and the charge nurse didn't say anything when I told her I held it, and when I reported my findings to the doc when I called to get the blood order and told him I held the Cardizem he was okay with it. I think I am still insecure as a cardiac nurse and just need to know if I did the right thing or not. I have really been reviewing my cardiac rhythms, meds, etc. but it's scary when I have to put what I know into practice!