Can you believe this ?!!?

  1. OK. So I have this crani that we were having a really hard time controlling her BP. Resistant to beta blockers, etc. So my preceptor (just started at a new hospital) tells me to give the Hydralazine that was ordered. Pt's HR was, like 115 so I didn't want to do it. Preceptor states that overnight RN did it with no problem. Checked chart to verify that the med had been given, noted no reaction reported in progress note or in report. Go into the room and ask the patient about it... at exactly the time the night nurse gave the Hydralazine ( at thattime the HR was almost 120), the pt experienced massive diarrhea, palpitations, further tachycardia and even a T-wave inversion ( I looked back in the monitor history)_ sooooo, I really did not want to give this drug. Well, after my preceptor almost forcing me to give the med (note SBP was in 170s- high but not critical and just 10 above goal), I just flat out refused. We worked backwards and, eventually, when one of the managers got into it, they ended up thanking me and commending me for making the call and refusing to give the med. But... would you believe that the pt's husband nearly killed me when I went into the room to ask the pt about her reaction to the med (believe it or not she was completely reliable and neuro intact)!!! He yelled at me and said a good nurse would know what happened overnight and how dare I ask her and blah blah blah. Of course no progress note or information in report was given to me about a reaction so there was no way I could do that. My only choice was to go to the pt and find out first hand. Well, the husband and daughter became very vigilant of me, didn't smile at me in the hallway when I had another assignment and even complained to another nurse about the situation. Can you believe it?!! Here I save this woman from an innapropriately ordered med and I get slapped... grrrr.
    Last edit by bluesky on Dec 24, '05
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  2. 9 Comments

  3. by   bluesky
    And, if you're going to say that there should have been a hold order for the Hydralazine, you are right. This particular institution doesn't use them. By the way, did you know that Hydralazine causes drug induced Lupus? Found that out today.
  4. by   Tweety
    Good call about the med.

    That arrogant family member needs a good slap. If only............
  5. by   HillaryC
    Quote from bluesky
    But... would you believe that the pt's husband nearly killed me when I went into the room to ask the pt about her reaction to the med (believe it or not she was completely reliable and neuro intact)!!! He yelled at me and said a good nurse would know what happened overnight and how dare I ask her and blah blah blah. Of course no progress note or information in report was given to me about a reaction so there was no way I could do that.
    That's infuriating. Don't you love it when non-nurses tell you how you should be doing your job? I don't know what we'd do without these people. I especially love it when they take it upon themselves to watch the monitors for me.

    I hope you just stood there with a smile on your face and accepted this guy's berating It's all about good customer service, you know
  6. by   zambezi
    Don't feel bad, even if the family members were rude...it was a good call on your part and you were being an advocate for the patient...I always ask my patients to tell me how meds affected them if the situation calls for it...even if the last shift gave me a good report that covered it...you were just covering your bases...just shrug those ungrateful family members off, they are just stressed (and rude to boot!).
  7. by   oldiebutgoodie
    Thanks for this post. I am a critical care nurse in an internship, and I have never given hydralazine. This prompted me to get out my pharm book and look it up. From what I gather, this isn't used much anymore??

    If pt was resistant to beta blockers (why would this be?), what would be other ways to bring down her BP? IV Nitroprusside?

    Thanks,

    Oldiebutgoodie
  8. by   PJMommy
    IV Nicardipine works well - and as a Ca++ channel blocker, it reduces risk of vasospasm. As for beta blockers, our docs don't use them a lot on the heads because, with beta blocked, alpha is unopposed and causes vasospasm.
  9. by   eqperez42
    Quote from bluesky
    OK. So I have this crani that we were having a really hard time controlling her BP. Resistant to beta blockers, etc. So my preceptor (just started at a new hospital) tells me to give the Hydralazine that was ordered. Pt's HR was, like 115 so I didn't want to do it. Preceptor states that overnight RN did it with no problem. Checked chart to verify that the med had been given, noted no reaction reported in progress note or in report. Go into the room and ask the patient about it... at exactly the time the night nurse gave the Hydralazine ( at thattime the HR was almost 120), the pt experienced massive diarrhea, palpitations, further tachycardia and even a T-wave inversion ( I looked back in the monitor history)_ sooooo, I really did not want to give this drug. Well, after my preceptor almost forcing me to give the med (note SBP was in 170s- high but not critical and just 10 above goal), I just flat out refused. We worked backwards and, eventually, when one of the managers got into it, they ended up thanking me and commending me for making the call and refusing to give the med. But... would you believe that the pt's husband nearly killed me when I went into the room to ask the pt about her reaction to the med (believe it or not she was completely reliable and neuro intact)!!! He yelled at me and said a good nurse would know what happened overnight and how dare I ask her and blah blah blah. Of course no progress note or information in report was given to me about a reaction so there was no way I could do that. My only choice was to go to the pt and find out first hand. Well, the husband and daughter became very vigilant of me, didn't smile at me in the hallway when I had another assignment and even complained to another nurse about the situation. Can you believe it?!! Here I save this woman from an innapropriately ordered med and I get slapped... grrrr.
    You did the right thing and that should make you feel really, really good of yourself. Patient's relatives, especially spouses, become defensive, and sometimes overbearing, the thing to remember is to play it cool. These people are in a strange place, scared, and unforgiving. (I have been there.)
    Just let it fly over, and learn. There will be two, maybe more (other relatives & patients) cases where, because of your conscientious mind, and care, will reward you with praises. I could almost write a book on the subject, and a few times, it was so bad, I wanted to change careers, but I love nursing, and I learned from it. Good Luck, Hope this helps a little.
  10. by   bluesky
    This post deleted
    Last edit by bluesky on Jan 4, '06
  11. by   rgroyer1RNBSN
    Dont worry you were right you probabley saved the pt. from another horrible reaction.:kiss And I love those morons who think they went to some form of nursing school and can watch our monitors for us to.
    I mean i went ot Lpn school for 1 year, RN for close to 2, and BSN for about 3
    now the way I figure I have about 6 years of higher education 2 off from the 8 of becoming a physician what do they have a 2 month first aide class

    Rodney, RN,BSN, ICU SHIFT CHARGE, CEN,CCRN,CFRN, working on TNCC

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