Did I Do Something Wrong?

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  1. This is a discussion on Did I Do Something Wrong? in General Nursing Discussion, part of General Nursing ... I came home and cried feeling like a truly incompetent nurse. I work on a very busy SDU/Tele unit...

    by Jul 10, '11
    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?
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    by rnccf2007 Jul 10, '11 10:51 am
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  2. 18 Comments so far...

  3. Jul 10, '11 by
    Though I am sure best practice would dictate to check. The fact that this patient had stable BP's through other doses, as well as a baseline previous BP WNL, I can't say I would have rechecked before giving the am dose.

    I don't consider myself a bad nurse, but perhaps this would be a learning opportunity for this patient and others under similar conditions.

    :uhoh21:
    sharpeimom, greenfiremajick, Crux1024, and 2 others like this.
  4. Jul 10, '11 by
    If I am giving it IV, yes.
    pinkchris2000, sharpeimom, Tryptophan, and 4 others like this.
  5. Jul 10, '11 by
    I usually do not take my patient's BP before giving diuretics. The only reason I would is if there was a reason too. You did nothing wrong as far as I could tell. It was just one of those things that happen.
    Forever Sunshine likes this.
  6. Jul 10, '11 by
    I don't usually unless the order has parameters.
    Not_A_Hat_Person likes this.
  7. Jul 10, '11 by
    Depends. If the pt is eating, drinking and the lasix is PO, then no, probably not. If it's IV and the previous BP's have been low, like the 0400, then yes, I would have.
  8. Jul 10, '11 by
    Quote from rnccf2007
    I came home and cried feeling like a truly incompetent nurse.
    Great post and discussion!

    I was at work the other day and we were talking about what makes great nurses or doctors. The vast majority of people seem to think really good caregivers have some sort of innate knowledge and skillset that enables them to perform very well.

    I disagree. What they have is experience. Just about anyone who is really good at something was really clueless at it at some point. They tried it, screwed it up and learned from their mistakes. Years later, people see them performing the same task and oooh and ahh.

    Congratulations on making another step toward becoming a great nurse AND for helping others by sharing your experience.
    JB2007, mlclove, Orange Tree, and 18 others like this.
  9. Asst. Admin
    Jul 10, '11 by
    Quote from 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?
    I agree If I'm giving it IV.......I will grab a quick B/P if it's low I would check with the MD.
    BonewaxRN and BluegrassRN like this.
  10. Jul 10, '11 by
    It would be one thing if baseline was above 100's systolic. becuase baseline was under 100 there's not much wiggle room. I would have checked to make sure, then hold medication if SBP <90. Don't worry about it though, lesson learned. just think about it this way though, what if the pt was in moderate to severe CHF also and you couldn't just bolus them. Then more invasive measures would be required like a presser drip and trip to ICU for close monitoring.
    Tait likes this.
  11. Jul 10, '11 by
    Sounds like in the end the MD needed to put a parameter on this medication. Also how aggressive was the diuresing? 20mg, 40mg, Q6, Q8, Q12?
    JB2007 and BonewaxRN like this.