bolus w/o order....yes or no? - pg.2 | allnurses

bolus w/o order....yes or no? - page 2

greetings all!! bolusing without an order....yes or no? background story to the question: i work same day surgery and we had a patient, male, late 30's, in phase 2 recovery s/p knee scope.... Read More

  1. Visit  sapphire18 profile page
    1
    Quote from SionainnRN

    When I worked in ICU we would often order labs, X-rays, etc and let the md know afterwards. But that's once they knew and trusted us.
    Yup. This. We often know what the patients need and what the MD is going to order. If they are unavailable, or it's the middle of the night, we do what we need to do and let them know after. This is limited to labs, EKGs, CXRs, if it's a more emergent situation, maybe some fluid. I'd rather use common sense than let a pt decompensate. Again- this is only with certain MDs who know us. They usually just thank us. However, every workplace, every situation is different.
    MedChica likes this.
  2. Visit  anotherone profile page
    0
    I wouldnt have done it . i have seen drs through major temper tantrums for nurses doing ekgs without an order on pts having chest pain
  3. Visit  eatmysoxRN profile page
    0
    I had a pt with a terribly low bp who I cranked fluids up on and trended them before I thought about calling the md. She was symptomatic. It wasn't secondary to a med reaction. The doc said good job and put in the order. We hang fluids on people in the early morning if their condition warrants and they don't have chf. If it was questionable I'd call.

    ~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~
  4. Visit  limaRN profile page
    2
    Quote from anotherone
    I wouldnt have done it . i have seen drs through major temper tantrums for nurses doing ekgs without an order on pts having chest pain
    Seriously?? They're angry because an EKG was done on a patient with chest pain? Get over yourself!
    kogafietsen and anotherone like this.
  5. Visit  sarahbeth2006 profile page
    0
    she is relatively new to the area....perhaps about 4 months there vs myself and everyone there being there for a year or so.....and this isn't something the MD would have ordered. can almost guarantee it.
  6. Visit  emtb2rn profile page
    3
    Quote from eatmysoxRN
    I had a pt with a terribly low bp who I cranked fluids up on and trended them before I thought about calling the md. She was symptomatic. It wasn't secondary to a med reaction. The doc said good job and put in the order. We hang fluids on people in the early morning if their condition warrants and they don't have chf. If it was questionable I'd call.

    ~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~
    The "nursing bolus". Do them all the time in the er, get the doc to put in the order so everything matches up. It's all about critical thinking. The environment counts a lot too.
    NurseOnAMotorcycle, MedChica, and Altra like this.
  7. Visit  anotherone profile page
    0
    Quote from limaRN
    Seriously?? They're angry because an EKG was done on a patient with chest pain? Get over yourself!
    Yes, It was pathetic. This doctor always threw ( i typed "through" instead of throw before lol) temper tantrums for everything. It was pretty comical. As this pt was pretty old and had a ton of cardiac problems.
  8. Visit  tewdles profile page
    2
    Nurses practicing in a specialty area for a period of time often practice in ways that "cut corners"...as in this instance, give the bolus then get the order. There is some jeopardy in this practice but some nurses feel comfortable enough with the physicians affiliated with the care that they are willing to walk the edge.

    Dependent upon the size and condition of a patient, a 500ml IV bolus shouldn't be too dangerous...but there are exceptions to that generalization.

    As others have said, many nurses practice in areas that have well developed treatment protocols and standing orders for medical and nursing care.
    MedChica and Orange Tree like this.
  9. Visit  CC Wisconsin profile page
    2
    On the Surg/Ortho floor, we give a 1,000 mL bolus for orthostatic hypotension (drop of >15 systolic). That order comes up with each surgical patient as a protocol. If the systolic drops, we give the bolus, then call the MD and notify him/her. Granted, we technically have an order in this situation, but we also prioritize.

    A patient saying that he is dizzy is not objective. Dizzy to me may mean passing out whereas dizzy to someone else may mean feeling a little light-headed. She should have at least checked his BP before deciding it was okay to bolus him.
    Susie2310 and MedChica like this.
  10. Visit  BelgianRN profile page
    5
    What's wrong with speaking to the RN herself? Why run to management. If you felt the need to spy on her patient care at least have the courtesy to go head on with her as well. There is too little direct communication nowadays.
    rockstar11, Altra, Hygiene Queen, and 2 others like this.
  11. Visit  jrwest profile page
    1
    This happened to me when I had a knee scope/bad reaction to dilaudid. The nurse called the anesthesiologist and got the order to bolus 500ml. It took her less than 2 minutes to get the order.
    I don't know why a nurse would want to take the chance of giving something without an order- especially when it shouldn't take that long in post op to get the order.It may be a different story if someone is vagal-ing, but there should be protocols in place.
    anotherone likes this.
  12. Visit  wooh profile page
    2
    Quote from netglow
    Maybe a call had been made, or will be made and the surgeon will sign without any hoopla... I've seen PACU and ICU nurses (especially) get and give first, let MD know after often. Again, you don't probably know this nurse...
    Yep. Textbook answer to OP: No. Don't do it.
    Real life answer: It happens.
    anotherone and BelgianRN like this.
  13. Visit  sarahbeth2006 profile page
    1
    It really isn't spying on her patient care at all when you work in an area as small as we do. I assisted her in bringing her patient back to the chair after using the restroom and then went back to my charting about 25 feet away. I fully understand and appreciate your comment that communication is definitely key but dislike the assumption that I was spying on her patient care.
    anotherone likes this.

close
close