Did I Do Something Wrong?

[rnccf2007]

I came home and cried feeling like a truly incompetent nurse. I work on a very busy SDU/Tele unit taking overflow from med surg. I had a patient who was being diuresed r/t chronic bladder retention and mild pleural effusion and was prescribed Lasix IV 40 mg q12h for the past 2 days. His BPs were stable with SBP in the mid to low 90s. At 0600, looked at his last VS (0400) and saw a BP of 98/60 (his usual trend) and his HR was 64 on the tele monitor. I did not take his BP and administered the Lasix. At 0650, a nursing assistant told me that the patients BP was 65/45. He took it twice. I went to check on the patient and checked his BP manually. I did not doubt the nursing assistant, but from experience I have seen that machines can be inaccurate. The machine was right. My patients other VS were stable and he was otherwise asymptomatic. Called the doc for a bolus and other orders. To make a long story short, I routinely take VS such as BP and HR before administering BP and cardiac meds, but have never done that for diuretics (even though I realize these meds can decrease BP). Do any of my fellow nurses take a pt's BP before administering diuretics?

[NurseyNurseKRN]

I do re-check blood pressures before I give IV diuretics and IV/PO antihypertensives. Remember, too, that if you are giving a medication at 0600 and the last BP was from 0400 then it is 2 or more hours old...and BPs can definitely change in that length of time for a lot of reasons. I will say though that it was very good that you looked at the BPs as a trend and not just as a single occurrence. In general, if the SBP is trending under 100 then I look back at the last time the medication was given and what their BP was then. I also use my coworkers as resources and look at their reactions and get an idea of what they would do. Lasix 40mg IV Q12 is a standard dose for diuresing, I am glad it was not 80mg! I think MN-Nurse said it very well, everyone who is a good nurse was at some point in their life clueless, no one is born a fully competent nurse! Everyone has had to learn and make mistakes! Do not beat yourself up over this. The good news is that the blood pressure was re-checked within 50 minutes and you were able to intervene appropriately. I think any nurse who will tell you they have never made a mistake would be lying to you. As far as I am concerned, its only a tragedy if you take nothing from the experience and let it repeat itself, which I am sure you won't =)

[tyvin, BSN, RN]

Check the BP when giving push/IV lasix; just something they taught me in school. I have run into other nurses who do not and it makes me nervous. If I say something it's not acknowledged as serious in this matter.

Experience is the best teacher. I also check the BP for myself just to be sure. It's not a diss on anyone, ultimately you're going to get the charge or doc who will ask if it was double checked.

[belle005]

I think you did great. Prior to admin, you looked at the BPs, noticed the trend was low, you thought it would be ok. The BP was rechecked when you learned it was low, you made sure the patient was asymptomatic and you called the doctor. I'm a new nurse, but that all sounds pretty reasonable to me. And now you'll do even better next time, because if you're giving IV lasix, you'll check the BP just prior to admin and you'll watch the patient even more carefully. I don't see any reason for you to beat yourself up here. Good work!

[KBRN413]

I always check before giving diuretics. We administered IV lasix at 0800 and 1600 here, I do routine vitals at those times anyways, but even before a one time order, I always check. Just to make sure!

[Been there,done that, ASN, RN]

You gave the lasix based on a BP taken within 2 hours. Acceptable, especially on that kind of a unit.

He had a borderline pressure to begin with. The drop in pressure was a RESPONSE to the med.

If he was asymptomatic, I would notify the doctor, watch closely and have just given the situation a little more time. I think the fluid bolus was the error here.

Let the body do what it can to adjust, we can't fix everything in a few minutes.

[Orange Tree]

I would not have checked before administration under those circumstances, either. If the patient had a SBP less than 90 (two hours prior) or a massive bleeding wound (oh no!), then I might have checked.

[RoyalPrince]

The problem is that at 0400 his SBP was already below 100. This becomes imperative to re-check his BP prior to giving Lasix 40 IV.