Lab test

  1. We had a lab test today and I'm feeling stupid and frustrated at the same time. Our "patient" ( a former nursing instructor) was on Lisinopril, Lasix, K-dur and a bunch of other meds. Her bp was 88/56 so I held the Lisinopril. I did not hold the Lasix or K-Dur. (her potassium was 4.0, no edema and her urine output was within normal limits). A number of my classmates did the same thing.

    We should have held the lasix, right? We all get so nervous for these lab tests!

    My frustration lies in the fact that we DO NOT have a pharmacology course in our program!!!! We go over meds for each unit we are in (we rotate through Peds, Neuro and endocrinology, Mental health, Oxygenation and then OB). I would love your opinions on a good pharmacology book that I can buy and study from myself.

    Thanks for letting me vent!
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  2. 12 Comments

  3. by   JMP
    Did they give you a diagnosis?? Why was this pt in hospital? That would be useful.
    Their BP was low...... but need to know more.........low due to reduced cardiac output? If so........ was CO low due to hypovolemia....... you say UO was OK...........but not what it was....... if hypovolemia is suspected then yes, hold their lasix. Sounds like a CHF pt. How in God's name due they expect you to know anything without a pharm course? What kind of program is this? Get yourself to a pharm course would be my advice! Yikes!

    Good luck

    JMP
  4. by   bassbird
    We were not given a diagnosis and when I asked about output the other instructor just said "within normal limits". Unfortunately my oxygenation unit doesn't begin for three more weeks.

    It will be interesting to see whether or not we were supposed to hold the Lasix.
  5. by   moonshadeau
    Working on a cardiac unit, if pressure was that low I probably would have held the Lasix, Lisinopril. Did the patient have any symptoms of having low blood pressure. Also was this a reading off an automatic machine. Sometimes those automatic machines are not always right. You have to check a manual and if it is still low then you need to recheck in like 30 min. You really should find a pharmacology class, whether in another program or online. Medical reference books are useful like Nursing Drug Reference, but you have to know what they are talking about. You have to know about binding drugs and interactions and common side effects. Highly suggest you find a pharm class. What kind of program is this anyway where they don't teach you about drugs?
  6. by   SharonH, RN
    Well it's hard to know without a diagnosis, more history, etc. But from just what you have told me, I would have held the Lasix with a BP that low, no edema and normal urine output. I also would have held the K+ since I held the Lasix.
  7. by   canoehead
    Of course you'd need to know the woman's normal BP, what are they shooting for? Maybe her normal is 90/? and this is OK for her. And did she just wake up? If this is am med time and you woke her out of a sound sleep give her a chance to sit up and wake for 15 min.

    Myself, I would have held the lisinopril and rechecked in 30 min, but if I felt that eventually all three meds needed to be held I would not do so without consulting the physician. So arguably this question does not end up being a nursing decision anyway.

    I agree that there is not enough info to make a real life call.
  8. by   debbyed
    Given the info. I would have also held the Lasix until:

    1. More info. available (Ie: baseline vital signs. underlying conditions)
    2. Recheck of vital signs in 15-30 min. showing increase in BP or;
    3. Consultation with physician
  9. by   bassbird
    We got our scores today for the lab test. I only missed one point and it wasn't the Lasix one. While it does feel great to have done well on the test, I still would like to know what I should do if I am faced with that scenario in practice.

    I guess I would have more information about the patient then what I was given and will make my decision based on the patient's specific condition. The weird thing about the whole affair was I got a different answer from each instructor that I asked!!!

    I think one of the best pieces of advice I have gotten is from my sister, who is an RN. She told me to never be afraid to ask questions. I sure intend to!

    Thanks to all of you for your replies.
  10. by   egmorgan
    Its difficult to decide what Medication to hold and not to hold in that incident. The law would suggest that you only hold a medication if it falls outside the parameters of administration. You can use your common sense, and knowledge about a patients condition and the actions of the medication. That is the critical thinking part of nursing. If in doubt, hold and call the MD. It is better to hold it than suffer the consquences, assuming that you get a decent answer from the physican within a few hours. Cardiac drugs are usually given first over duiretics, unless the patient is having trouble breathing etc, it was a difficult one, but you know there are many nurses that would do the same thing, me included. Its good that you are thinking about that one.
  11. by   RNPD
    Basically I would never hold a med w/o consultaton with the doctor or specific written parameters from the doc. Yes, if I had an antihypertensive to give and the B/P was 90/60 & the patient's baseline was 130/85, I would hold the med and call the doc. If I couldn't get an answer within an hour or so i'd go to my supervisor and ask what i should do. Usually they start calling the doc, but at that point you have someone higher than you agreeing that you should hold the med and they have more time than you to chase down the doc. But as canoehead states, it is not ultimately a nursing decision.

    As for lasix, i rarely hold it unless the patient has symptomatic hypotension. As far as 88/56, this could be a perfectly normal B/P for this patient. The scenario didn't give abnormal s/s, only abnormal labs. It is very difficult to base a decision on numbers alone. Always remember to look at the PATIENT, not just the numbers!
  12. by   Dave123
    Lasix does have a mild vaso dialating effect. Which as you know lowers BP.

    We have just started using Lasix in the ER in nebs (with other meds) to help dialate the airway in our COPDers and Asthmatics. Seems to be helping.

    But I agree that in this senerio there is little information to really base a decision.


    Just my opinion


    Dave
  13. by   canoehead
    Dave

    Does nebulized lasix increase output as well?
  14. by   Dave123
    I seems to also have a moderate urinary effect when introduced through the lungs. But as you know when you get a bad respiratory distress pt, its an airway issue.

    We have been using it in this mixture, albuterol 1cc/solu-medrol 20mg/lasix 10mg/ 2ccNS. Mainly with our COPDers.

    dave

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