Why would these IV meds be on my tomorrow patient's chart?

rnmalex · Sep 24, 2012

Yep. That actually happened last spring during my final semester of nursing school. It was really awful. TPA is a fibrinolytic that comes to mind. In this case, it's better to prevent than to treat.

Creamsoda, ASN, RN · Sep 24, 2012

sounds pretty good!

Pretty much most patients that are hospitalized are at risk for stress ulcers, hence the protonix.

nay9818 · Sep 24, 2012

Ah my educator has asked me to do the exact same with my pt's drug. Eeekkkkk

Esme12, ASN, BSN, RN · Sep 24, 2012

And one of the things my preceptor wants us to do is to go in the day before (that is, Sunday) and write down all the assigned patient's meds. And then she'll ask us what those meds have to do with the patient's diagnosis.
So my patient is post-op for right hip arthroplasty, and I kinda wanted to go over the non-PRN meds that patient is listed for.
- Lactated Ringers IV
- Sodium Chloride 0.9% IV
- Colace/Docusate Sodium PO
- Lovenox Subcut.
- Oxycontin
- Paxil
- Protonix
Let's see if I get this right...
The patient's on the lovenox because if he/she's post-op we don't want him/her to get DVTs or pulmonary emboli, and thus the lovenox is given prophylactically.
Colace is an orally ingested stool softener, and since the patient was under anesthesia for the arthroplasty, he/she may have less BM d/t the relaxed GI system. Also, the patient's stuck in bed, so that further increases the risk of him or her getting constipated.
Oxycontin (as half this Earth knows!) is a painkiller. Obviously, the patient's post-op pain is managed while on this drug. One thing I'd note is that the drug starts taking effect in about 10 to 15 minutes, and peaks a little after 1 hour, so I'd probably do an assessment of the patient at the time to check for level of consciousness. (Am I right?) YES
Paxil is an antidepressant. Hmm. No clue what that'd have to do with the admitting Diagnosis. I'll just say it's a home med.
Protonix is used to treat GERD. Hmm, but this patient's binder never said that he/she had GERD. I don't get it.
Okay! Hopefully that made half as much sense to you as it did to me :)
Sooo, my question is this:
Why would the patient be on IV Lactated Ringer's and normal saline?

The colace may be ordered for the immobility of your patient or may be just for the narcotic use by this patient.

The Paxil may not have anything to do with the admitting diagnosis but may have everything to do with a pre-existing condition. The same with the Protonix. Some OD's will order the Protonix to decrease the production of acid in the surgical NPO patient.

The patient will be ambulated, at least, as per MD order. Did this patient require a walker before admission? Sometimes a walker is use in place of other assistive ambulatory aids becaus ethey are unsteady/unable to use crutches.

LR and 0.9 are common IVF in the OR.......are they still ordered? These charts may help explain it for you

attachment 5949 chart of commonly used iv solutions

attachment 5812 chart of commonly transfused blood products on post #22 of this thread is a description of hypotonic, isotonic and hypertonic iv solutions with a link to a listing of which iv fluids fit into each category. https://allnurses.com/nursing-student...iv-127657.html

Good Luck!!! You are off to a great start!

classicdame, MSN, EdD · Sep 24, 2012

a lot of times the fluids are ordered "just in case" patient needs them to keep hydrated, to prevent constipation from pain meds, to provide route for IV meds----

KelRN215, BSN, RN · Sep 24, 2012

Lol, actually, my nursing preceptor assigned each of us the patient's room number, so I didn't have much of a choice in the matter
Wait!! Is the patient walking because ambulation decreases the risk of DVTs and/or PE? That would make sense, if that's what it is.
But how often is the nurse supposed to get the patient ambulating on the walker? I was already a bit overwhelmed by the computer system as it is, so I definitely couldn't find "Walk the patient q4h" (for instance) on the nursing interventions section.
Well, for starters, the RBCs have blood components. LS and NR may be isotonic with blood, so they won't necessarily cause fluid shifts within the body or fluid/electrolyte imbalances, but they do lack things like hemoglobin.
(Am I getting lost? Am I way off?)
I did look up the patho for a hip arthroscopy and I sort of wonder what kind of complications could result from ambulation.
As for the protonix, I think TLH1999's reply made sense to me. If the patient were on that drug, then he or she would have less of a risk for GERD. How does epidural anesthesia affect the GI system, though? Don't epidurals for hip arthroplasties just affect the lower half of one's body?

Some MDs have a habit of putting EVERY post-op patient on a PPI or a H2 antagonist for "gut protection" while in the hospital. There is evidence for the use of these meds in the ICU but little evidence to support its use in the general hospital population:

Stress ulcer prophylaxis in hospitali... [Am J Health Syst Pharm. 2007] - PubMed - NCBI

When I worked in the hospital, absolutely EVERY patient in the ICU came to the floor with an order for IV Zantac q8hr. Didn't matter if they were 4 days post-op, had been eating since POD #1 and only remained in the ICU because there were no floor beds available, they'd still be on IV Zantac. That would be immediately dc'd as soon as they hit the floor unless they were on steroids and, if they were on steroids, it would be changed to PO.

nurseprnRN, BSN, RN · Sep 24, 2012

Colace, stool softener, really ought to be started preop. Why? Your rationales for that are a good guess, but when you think that many meds we give people are to deal c side effects of other meds, can you think of why this and perhaps Metamucil/other fiber should be started preop and continued postop? Huge, huge problem in postop patients of nearly every stripe.

.

flyingchange · Sep 24, 2012

Aha!! Then the clot would dislodge and quickly go to the area of lowest pressure (i.e., the lungs), and then it would become a pulmonary embolism and you'd have a major crisis on your hands! I think they give fibrinolytics ('clot busters') to patients who actually have a clot, instead of those who are at a risk for a clot, in those cases.
Am I right?

You are! (Although Lovenox is also first-line tx for known or suspected PE in my ED, and 9/10 times PE is not a crisis but something to be treated within 24 hours)

I didn't reply just to say that though. I wanted to mention that I am very impressed with the way you show your thought process. You will do great in your rotation!

meanmaryjean, DNP, RN · Sep 24, 2012

Some MDs have a habit of putting EVERY post-op patient on a PPI or a H2 antagonist for "gut protection" while in the hospital. There is evidence for the use of these meds in the ICU but little evidence to support its use in the general hospital population:
Stress ulcer prophylaxis in hospitali... [Am J Health Syst Pharm. 2007] - PubMed - NCBI
When I worked in the hospital, absolutely EVERY patient in the ICU came to the floor with an order for IV Zantac q8hr. Didn't matter if they were 4 days post-op, had been eating since POD #1 and only remained in the ICU because there were no floor beds available, they'd still be on IV Zantac. That would be immediately dc'd as soon as they hit the floor unless they were on steroids and, if they were on steroids, it would be changed to PO.

Virtually all of our patients in the PICU are on what we affectionately refer to as 'life-saving Pepcid'!!!

nurseprnRN, BSN, RN · Sep 24, 2012

Don't forget that as an H2 (histamine 2) blocker it will also have ...d'oh...antihistamine effects. Maybe helpful for minor blood component allergy. (I learned this when my allergist included it in a cocktail of meds with antihistamine effects for an idiopathic allergic reaction. Doxepin does too. Who knew?)

sapphire18 · Sep 24, 2012

I have never heard of Lovenox being used to treat a PE. I've only ever seen heparin or agatroban(sp?) drips for this. I really think with a PE or DVT you would need a faster effect- as in something IV. Anyways...wondering how the OP's first day went!

nurseprnRN, BSN, RN · Sep 24, 2012

To review the use of anticoagulants in DVT or PE: Anticoagulants do not treat clots. Anticoagulants decrease clotting ability so a clot will be less likely to form, and if formed already, will be less likely to grow.

If you review your physiology you will discover what happens to clots already formed in the body-- do they sit there forever? Nope. What your anticoagulant does is hold the fort until those clots are dealt with by other forces (which you will go look up now).

Don't feel bad, it's a depressingly common misunderstanding, which (alas) then spills over into inaccurate or misleading patient teaching. Get it right now and you'll never forget it.