Coreg med and no heart rate parameters? - page 2

by amber7591 7,965 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


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    I was always taught to hold a beta blocker if the HR is <60bpm or SBP <100, though some docs will write to hold if SBP <90. Look at the overall picture and the patient's trends, though.

    When in doubt, call the MD, unless there are specific parameters written.
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    I agree, Coreg is not one of the meds I would hold, simply based on a patient's heart rate. Yes, you do need to look at the whole picture. If there are no written parameters, then call the MD. I am shocked about all the people who say they were "fired" for one mistake.
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    I'm so sorry this happened to you. Go forward now, I wouldn't put on resume though.
    It's a lesson learned in
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    Somehow 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.
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    Quote from psu_213
    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.
    Ok, 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.

    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
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    The 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.
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    True, more persons are fired for not getting along with the wrong person than for poor performance.
    Quote from Sadala
    The 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.
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    Quote from Sadala
    Ok, but. If someone is precepting, isn't it always better to CYA?
    I 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?
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    Iam sorry this happen too you. Its hard to believe that you were fired for just one incident. The magical number 60 comes from what is a normal heart rate anything less then 60 is considered Bradycardia.
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    That's kind of harsh; personally I always hold the medication if its less than 60. But I agree that parameters should have been given to give or not to give


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