BP situation - page 3
I just completed my orientation and was released so I am a newgrad LVN working fulltime days. I had a situation with a pt who has a Hx of HR of 60 at best he has bottomed out before around 45bpm when... Read More
0Dec 14, '12 by twinkletoes53I would have felt more comfortable with having the MD write an order specifying something like "Patient's HR is 50; give Digoxin as ordered". Because if something untoward had happened to the patient, it would have been your word against his.
I worked in pediatrics; it was unit policy to have 2 nurses check Digoxin dose. We also documented patient's HR in MAR at time the medication was given.
Just wondering, does your unit check a Digoxin level if the patient's resting HR was below a certain level? Especially if HR has changed from that the patient's baseline.
0Dec 14, '12 by Standoe3K was 3.1-3.2 it was replaced and no labs for the previous 3 days. And for dig levels I don't recall seeing a lab for that. All the nurses on my unit document BP and HR with all cardiac medications and K levels with Potassium meds/ k wasting ect.
0Dec 14, '12 by psu_213, BSN, RNQuote from RN2B123In nursing school, VS were either normal or abnormal. While some instructor mentioned that all normals are individualized, the prevailing thought in school is that any HR less than 60 HAS to be abnormal, and therefore is the cutoff for any med that lowers HR. In practice, this is not true. We had a pt whose HR was hovering the in the high 50s, low 60s. He had a cardiac hx. and was having some nonspecific EKG changes. The cardiologist wanted him Beta-blocked to a HR in the 40s. The nurse, who was a relatively new nurse, was dragging her feet about giving him his lopressor because his HR was often below that 'magic number' of 60 (even the the cardiologist was quite clear he wanted the HR to be much lower). In an appropriate way, the cardiologist 'got on' the nurse to get in there with the med to get the HR down.How come in NS they teach you to "always" hold Dig/cardiac meds if HR is less than 60 bpm. At least that's what I was taught to do...was I misinformed then? They made such a big deal over it too...
1Dec 14, '12 by Anna Flaxis, ASNQuote from cardiacrocksNot to hijack the thread, but I have never heard of lisinopril having any effect on HR. Can you explain this comment?Coreg and lisinopril can also lower HR. Either way you did the right thing, way to go!!