New nurse here on a busy med surg floor. What medications would you not give together?? Such as sleeping meds, anxiety meds, pain meds...etc.
also, what nursing parameters do you rountinely follow when it comes to blood pressure and holding a no medication? Or holding other meds?
Thanks in advance. Everyone is always so willing to give novice nurses advice, I love this site!!
Have you consulted your facility's policies? It is quite likely that for certain medications there are already existing parameters for when to hold them.
I'm in my first year as a nurse too and on Med/Surg, definitely check your facility policy. But as an example, ours with BP meds is usually hold metoprolol for systolic 90 or less...but if my patient's systolic is 95 and they have had recent trouble with hypotension then I will hold. As far as giving certain meds together in my short time I have learned to make those assessments based on the individual patient if there is no policy or hard and fast rules against it.
The most important thing I have found is to communicate with the MD regarding those kinds of assessments so they know what is or isn't helping the patient as well. Especially being a new nurse, I have occasionally thought I was making a good call only to discover I was missing information. Good communication has caught those errors every time so far.
I hold meds when the pt has multiple narcotics and sedatives scheduled for the same time. I wait approx 1 hr between doses and check BP and Resp Rate before giving the next dose.
Depends on a lot of things. If my patient says he/she takes oxycodone, tramadol, and Ativan every night before bed when at home, I would give all three together to maintain their routine as long as their vitals are stable and the patient is alert - the patient probably has a pretty high tolerance to these meds anyway. If I had a patient who was here for acute pain and was on IV Dilaudid that they've never taken before, I might check their vitals every couple of doses or so just to see how they respond.
As far as blood pressure meds - if there aren't clear parameters (best case scenario but doesn't always happen) I usually hold if SBP <100 or HR <60. If the patient normally has soft BPs and runs a little brady, I will hold if SBP<90 or HR<55. However, if it's a more complicated case (i.e patient here for rapid afib, HR=115, BP 94/50 - Lopressor or no?) I'd run it by the provider and then ask to put parameters in.
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