Published Jan 23, 2013
You are reading page 2 of bolus w/o order....yes or no?
True, but depending on the nurse, and in what role that nurse has worked and what she knows about this particular surgeon, etc. this might not be soooooooooo odd. Each nurse decides what they are going to do about any given situation. Maybe a call had been made, or will be made and the surgeon will sign without any hoopla... I've seen PACU and ICU nurses (especially) get and give first, let MD know after often. Again, you don't probably know this nurse...
When I worked in ICU we would often order labs, X-rays, etc and let the md know afterwards. But that's once they knew and trusted us.
Yup. This. We often know what the patients need and what the MD is going to order. If they are unavailable, or it's the middle of the night, we do what we need to do and let them know after. This is limited to labs, EKGs, CXRs, if it's a more emergent situation, maybe some fluid. I'd rather use common sense than let a pt decompensate. Again- this is only with certain MDs who know us. They usually just thank us. However, every workplace, every situation is different.
anotherone, BSN, RN
I wouldnt have done it . i have seen drs through major temper tantrums for nurses doing ekgs without an order on pts having chest pain
eatmysoxRN, ASN, RN
I had a pt with a terribly low bp who I cranked fluids up on and trended them before I thought about calling the md. She was symptomatic. It wasn't secondary to a med reaction. The doc said good job and put in the order. We hang fluids on people in the early morning if their condition warrants and they don't have chf. If it was questionable I'd call.
~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~
limaRN, BSN, RN
Seriously?? They're angry because an EKG was done on a patient with chest pain? Get over yourself!
she is relatively new to the area....perhaps about 4 months there vs myself and everyone there being there for a year or so.....and this isn't something the MD would have ordered. can almost guarantee it.
emtb2rn, BSN, RN, EMT-B
I had a pt with a terribly low bp who I cranked fluids up on and trended them before I thought about calling the md. She was symptomatic. It wasn't secondary to a med reaction. The doc said good job and put in the order. We hang fluids on people in the early morning if their condition warrants and they don't have chf. If it was questionable I'd call.~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~
The "nursing bolus". Do them all the time in the er, get the doc to put in the order so everything matches up. It's all about critical thinking. The environment counts a lot too.
Yes, It was pathetic. This doctor always threw ( i typed "through" instead of throw before lol) temper tantrums for everything. It was pretty comical. As this pt was pretty old and had a ton of cardiac problems.
Nurses practicing in a specialty area for a period of time often practice in ways that "cut corners"...as in this instance, give the bolus then get the order. There is some jeopardy in this practice but some nurses feel comfortable enough with the physicians affiliated with the care that they are willing to walk the edge.
Dependent upon the size and condition of a patient, a 500ml IV bolus shouldn't be too dangerous...but there are exceptions to that generalization.
As others have said, many nurses practice in areas that have well developed treatment protocols and standing orders for medical and nursing care.
On the Surg/Ortho floor, we give a 1,000 mL bolus for orthostatic hypotension (drop of >15 systolic). That order comes up with each surgical patient as a protocol. If the systolic drops, we give the bolus, then call the MD and notify him/her. Granted, we technically have an order in this situation, but we also prioritize.
A patient saying that he is dizzy is not objective. Dizzy to me may mean passing out whereas dizzy to someone else may mean feeling a little light-headed. She should have at least checked his BP before deciding it was okay to bolus him.
What's wrong with speaking to the RN herself? Why run to management. If you felt the need to spy on her patient care at least have the courtesy to go head on with her as well. There is too little direct communication nowadays.
martymoose, BSN, RN
This happened to me when I had a knee scope/bad reaction to dilaudid. The nurse called the anesthesiologist and got the order to bolus 500ml. It took her less than 2 minutes to get the order.
I don't know why a nurse would want to take the chance of giving something without an order- especially when it shouldn't take that long in post op to get the order.It may be a different story if someone is vagal-ing, but there should be protocols in place.
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