Coreg med and no heart rate parameters? - page 2
by amber7591 7,994 Views | 19 Comments
I just started as a nurse on a medical floor, I was on orientation. I had a coreg to give and the heart rate was 52, there was no parameters entered by the physician so I went ahead and gave it. Unknown to me, my preceptor came... Read More
- 0Apr 7, '13 by heartnurse2012Somehow it didn't finish. Whenever you come across these meds again, from the beginning ask when to hold or give this medication. The hospitalists always give those orders, as far as the cardiologists it's like pulling teeth with them but its our license we have to protect.
- 0Apr 9, '13 by SadalaQuote from psu_213Ok, but. If someone is precepting, isn't it always better to CYA? If HR<60, SBP<100 no parameters aren't you going to talk to SOMEONE, the charge nurse, your preceptor, SOMEONE and say, hey, I just want to check this out, pt's baseline HR is blah blah blah, right now it's 55. I see he's been taking x med for a while now with this low baseline but no listed parameters here and I feel better checking this out with someone else first since I'm new.What was the error here. There were no parameters given for the med. One could argue that you should have made a call to the doc. That's about the only issue you could have here.
FWIW, I have seen situations where pt's are beta blocked into the 40s and parameter for the dose is "hold for HR < 45." 60 is most definitely not a magic number, and if nurses on this unit feel that 60 is the definitive cut off level, they need some (re)education in the matter.
I guess I'm always thinking, worst case scenario, I want to have brought this up with someone. I mean, I'm in clinicals now, but I see something wonky and I report it off and document that I reported it, to whom, etc. I mean, what do I know, experience wise, compared to someone who's been there for years? So maybe I'm the world's worst PITA, but why wouldn't you ASK.Last edit by Sadala on Apr 9, '13 : Reason: clarification
- 0Apr 9, '13 by SadalaThe other thing - I agree with a couple of other posters who asked if there was any other reason they might have wanted to terminate you, personality clash, anything? I think its true of all employment (not just nursing) that people get told the real reason they were fired about as often as they're told the real reason they weren't hired. That is, not very often.
- 0Apr 10, '13 by morteTrue, more persons are fired for not getting along with the wrong person than for poor performance.Quote from SadalaThe other thing - I agree with a couple of other posters who asked if there was any other reason they might have wanted to terminate you, personality clash, anything? I think its true of all employment (not just nursing) that people get told the real reason they were fired about as often as they're told the real reason they weren't hired. That is, not very often.
- 0Apr 10, '13 by psu_213Quote from SadalaI agree that you should CYA and the person you should talk to is the doc. However, unless there is a written policy for the unit/facility, then a HR of 60 is not a definitive cut off Coreg (or any other med). If it is given despite a "lowish" HR (e.g. 55) and the pt has an episode of symptomatic bradycardia, then, well, there will be an issue if the nurse did not cover his/her rear by calling the doc before giving the med. Otherwise, there should no be any problems giving the med even with the stated HR--in other words, if the pt tolerated the med just fine, why punish the nurse for giving the med without calling the doc?Ok, but. If someone is precepting, isn't it always better to CYA?