Medication tidbits an ER nurse should always know

[RNstdntSVSU]

Hi all...I am currently doing an externship in the ER and even though I can't administer medications, I've picked up on a lot of important facts you have to remember about certain medications from watching my preceptor. Things like potassium and any other electrolytes always go on a pump with the pt on the monitor, bentyl is never given IVP, always put older people on a spo2 with narcs, IV antibiotics can make people hypotensive. I was just reading another thread about inapsine sending people into prolonged QT and arrhythimas which is something I've never heard even though we've given our pts inapsine. So I want to know...what are those things I should ALWAYS think about when giving certian meds? I'm sure theres a ton more out there!

[ron27]

Ceftriaxone (Rocephine) :)

[Anoetos, BSN, RN]

The problem with hydralazine, Brainkandy, is that it's unpredictable, for every ten patients it works for, there are two or three for whom is either does very little or does too much.

That said, I love beta blockers, especially Lopressor for heart rate control in tachycardic pts. I always question it for BP control, it's only mildly effective and even then usually in conjunction with HCTZ or some other diuretic.

[Anoetos, BSN, RN]

I only dilute dilaudid for opioid naive patients. For those with chronic pain and high tolerance I push it hard and fast and I always flush. They appreciate it.

[CP2013]

I only dilute dilaudid for opioid naive patients. For those with chronic pain and high tolerance I push it hard and fast and I always flush. They appreciate it.

I gave dilaudid to a patient, and split it in TWO 10cc saline syringes. She kept asking me to push it fast and I told her no because I didn't want her to experience a sudden drop in blood pressure or change in consciousness and how slow administration was necessary for safety.

To be honest, I just got tired of her demands for narcotics every 30 minutes and her calling the hospitalist answering service to try to get the doc to order dilaudid and morphine alternating.

The resident came in and told her "This isn't burger king, you CANNOT have it your way"

Best moment ever.

[Anoetos, BSN, RN]

I read up on the hypotensive effects of dilaudid and they're actually negligible except with chronic use. I did this after a patient died on me.

[turnforthenurse, MSN, NP]

Dilantin should only be mixed with NS; other diluents can cause it to crystallize.

Valium cannot be mixed with anything, not even NS.

[Sassy5d]

[quote name=

Valium cannot be mixed with anything, not even NS.[/quote]

I have not given Valium iv yet, if u can't mix due to potential for crystallizing, how do you give it? And there's no risk when u flush the line?

[CP2013]

I read up on the hypotensive effects of dilaudid and they're actually negligible except with chronic use. I did this after a patient died on me.

I just didn't want her to get the high. She kept showing up with vague complaints and hopping from ED to ED and managed to convince a doctor admit her AND prescribe dilaudid for toe pain.

No fast push for you! Over 1 minute per syringe! She was getting 2mg q6h and was requesting morphine q4h for "breakthrough" toe pain.

It took everything I had not to roll my eyes.

[emtb2rn, BSN, RN, EMT-B]

Valium cannot be mixed with anything, not even NS.

Dunno about that. There are 2 studies that say it can be added to NS or D5W. Check RxMed: Pharmaceutical Information - VALIUM and Compatibility and stability of diazepam injection following dilution with intravenous fluids (yeah, yeah, I know it's from '78). Interestingly enough, our internal medication program returns a message of "]Results uncertain, variable or dependent on conditions"

[Anoetos, BSN, RN]

I think sometimes patients get caught up in a cycle which ends up generating narcotic dependency and we are as at fault for this as they are.

Let's say they get a spinal fusion which never really takes, sure, their spinal cord is now protected and intact, but they still are dealing with chronic pain. They get scrips for Vicodin and Oxy which they never really get off of and they require higher and higher doses just to manage the pain and they don't really have anything for breakthrough. So they come to the ED, where we call them "seekers" and deny or at best dilute their pain control measures.

CP I am NOT saying this is the case with the pt you're talking about. I am just pointing out that we, just because we're nurses, don't necessarily always know what is best for every patient.

Frankly, if it's ordered, I give it. If the pt isn't opiate naive, I don't cheat them just because I have moral qualms about the choices they may have had to make due to a medical condition.

[Anoetos, BSN, RN]

But more directly to your case, why deny the pt what they want? If they have a high tolerance to opioids it's unlikely that 1mg of dilaudid is going to do much for them. Certainly not as much as for the naive. The likelihood that you'll do them harm is very small also.

Again it comes down to judging our pts and while it's certainly true that we use our judgment to assess them, that's not the same thing. I guess I just don't understand the gatekeeper mentality many nurses have about opioid pain meds. They are actually metabolically, very benign and only a hazard to a pt who is already severely hypotensive or in respiratory distress.

[Sassy5d]

But maybe people aren't talking about the pt in chronic pain situations. Maybe some are talking about the person addicted to heroin who is coming in for dilaudid and Benadryl. ER doctor's and nurses are not pain curers. I feel a little uneasy slamming iv Benadryl and dilaudid fast just because the doctor ordered it, and I know the pt will be so thankful I just got them high.