I am a new Nurse in LTC. I have a question about your bowel regimen. If our residents have not had a bowel movement by the 3rd day they get 30ml of MOM. I was doing meds on this day and a resident that was due for MOM had a high Magnesium level that day. ( I only know cause I reported the labs to the doc that day. ( cant remember what her problems were, but doc just ordered repeat labs) Should she have had the MOM this day?
Another situation, a resident with kidney problems gets 40Meq of potassium everyday. He only gets lab workup 1x week. I am not comfortable giving potassium without knowing his most recent level. What do you all do in this situation?
What are some of the things I should be looking for in situations like this?
May 30, '12
The decision on whether to give the patients meds depends heavily on their diagnosis and previous medical histories and what the is EXACT level of the lab result and the importance of the med.
The first patient. I would see that the Mg+ level is elevated. I would think .....how elevated? Has this patient ever had this issue in the past? Does the patient have nay medical comorbidities that would elevate the Mg+ level. What have the Mg+ levels been in the past? Is this a "fluke"? Or a part of the patients medical problems. What do I know about hypermagnesium?
I would hold the MOM........Knowing it was elevated I would check with the MD on whether he wishes the patient to have the MOM. Maybe get order for something else if the patient was constipated.
The renal patient. That would also depend on the medical history. Is the patient in "renal failure" with dialysis? or just "renal insufficiency" with a history of an elevated Bun/Cr. What is the patients past K levels. Do they run high? What is the trend of the patients K+ levels? Is the patient on diuretics? The past history of this patient is very important. My mother is renal insufficiency. Her kidney functions run a little high sometimes. Her Potassium has never been elevated. She is on Lasix (a non potassium sparing diuretic) and has low K+ levels in the past. She gets potassium supplement and monthly labs......there hasn't been a problem yet. (knock on wood).
The answer to your question is check the chart. Check the patients history/trends in lab. Check the patients diagnosis and comorbidities and how do they correlate to this patient and their meds.
When in doubt...... Call the MD. I'd rather be yelled at for bothering the MD than libel for hurting a patient.
Good questions. Good luck!