I&O Goal Clarification & Nipride vs Nitroglycerin

[nurs1ng]

Have 2 questions -

1. Can someone clarify the I&O goal, for example, let's say 2 L in, 3 L out?

I understand that keeping the pt dry (esp heart patients) is pertinent to decrease the demand and workload on the heart. Since this is a 24-hr I&O, is the night nurse responsible for keeping track of the I&O goal for the whole 24 hrs?

2. MD ordered nitro drip for a pt with a recent RV infarct. I understand that nitro drip is a vasodilator more potent on the arterial side. Would just like thinking behind the MD's brain on why Nipride wasn't considered.

Any details and clarification would help.

Thanks!

[NRSKarenRN, BSN, RN]

Night shift has always been responsible to 24hr I+ O totals in 5 hospitals I've worked. I + O goal individualized.

[h=3]Sodium Nitroprusside Monograph for Professionals - Drugs .[/h]

[kool-aide, RN]

I think nitroglycerin may actually work more toward venodilation. This would be useful in an RV infarct as not to overload the RV with preload.

[hawaiicarl, BSN, RN]

1. 24 hour ins and outs ends at the end of your shift .... so basically it works out that you need to do a 12 hour in and out with the remainder. In your example let's say on days he had 1500 in with meals and po in etc, that leaves you a total of 500 for your shift. On the other end if he urinated 1000 during days, you should proabably hit up the night doc for some lasix, because you need 2000 out in 12 hours. Not sure if that helped you make sense of it or not, sort of like a relay race, and you are running the anchor leg.

2. Nitro is a vasodilator which in addition to reducing afterload, can also increase the patient's vfib threshold. Nipride is a potent vasodilator that can increase pulmonary shunt, cause coronary steal, and with use >48 can cause cyanide poisoning. Some studies also show nipride can have arrhythmogenic effects in up to 3% of patients.

Cheers

[Mully]

I think nitroglycerin may actually work more toward venodilation. This would be useful in an RV infarct as not to overload the RV with preload.

This.

Nitro is purely venodilation, with a small amount of arterial dilation at really high doses.

Nipride is a mixed dilator, meaning it dilates both venous and arterial sides.