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?
Jul 10, '11
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 =)
Last edit by NurseyNurseKRN on Jul 10, '11