reasonable,prudent and no parameters?

1. I held a lasix 20mg for a older gentleman whose bp was 82/50,I also noticed the bp was low 3 times that month, we are taking bps cause he has a low dose cardiac med which has bp parameters when to hold, but the lasix was given any way, I guess cause there were no bp parameters when to hold,I also know this person has fallen before, so I suggested to the md we have bp parameters to hold the lasix and got them.
   Later in the day the HN informed me that the elderly dont take their bp at home before taking their meds,like lasix,so why do it at the hospital? and because the pt. load is so great on the floor and because taking the bp is time consuming and that the unit will be trying to eliminate orders to take bps and hence parameters on meds like lasix, and based on this information ,she instructed me in the future not to get bp parameters for meds like lasix.
   The HN got abit irritated I gave her the rational why we should be taking bps on this patient,please note,Im not ragging on this HN,in most cases I have great respect for his judgment.
   My question is...What is the most reasonable and prudent thing to do in this situation?

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2. 

   About ohbet

   Joined: Jun '01; Posts: 430

   22 Comments

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3. 
   Apr 2, '03

   I agree with holding the Lasix.
4. 
   Apr 2, '03

   Don't get BPs because we might have to do something if they're whacked? What kind of nursing CARE is that?
   
   I'd have held the Lasix too. And asked the doc for parameters. I wonder is the gentleman getting electrolytes checked? Low Na or K+ can do a job on the oldies too.
5. 
   Apr 2, '03

   Did you tell your head nurse that many elderly people wind up in the hospital BECAUSE they don't monitor certain conditions like BP at home and wind up passing out, falling, and cracking their skulls when they bottom out? And maybe dehydration isn't an uncommon thing in elderly folks? And that medication doses can be adjusted if needed based on patient response? (Smack her! ) Sorry - had a patient with just that case recently. If we weren't monitoring people, there would be no reason for them to be under our care. Good for you for watching and using your critical thinking skills. If we weren't supposed to think, any monkey could rip open pills and put them in a cup.
6. 
   Apr 2, '03

   Good for you. While they don't check it at home and that may very well be normal for them, it doesn't save your license if he dies.
   
   Did you call the doc?
7. 
   Apr 2, '03

   The patient/license would be what I would protect also. Really, how long does it take to get B/P?
8. 
   Apr 2, '03

   Originally posted by P_RN
   Don't get BPs because we might have to do something if they're whacked? What kind of nursing CARE is that?

   LMAO! Exactly!
   
   "Um, yeah, don't take that BP, cause you already have too much to do, what, with all that bullsh*t paperwork we give you"
   
   Sometimes I fantasize that the hardest thing I ever have to do at work is go back and super size a combo meal.
9. 
   Apr 2, '03

   Licensing Review Board: "So you gave this drug without checking vitals first, is that correct?"
   
   Nurse: "Yes."
   
   LRB: "And why didn't you check them?"
   
   N: "My boss told me not to, and the doctor didn't set parameters."
   
   LRB: "Would you like fries with that?"
   
   
10. 
    Apr 2, '03

    And please don't waste your time checking temps either because people at home don't check their temp every day and now that I think about it assessing the patient wastes precious minutes that you could be spending in committee meetings. How about if you tell your head nurse that you don't plan on changing the bed today because the patients don't change their beds at home every day either?
11. 
    Apr 2, '03

    ROFLMAO!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!You guys are sooo good! I know where to go for advice when I start working!
12. 
    Apr 2, '03

    Well, ohbet, I agree with you, and the other posters. Prevent falls, and you prevent fractured hips, concussions, etc. And while we are at it, why keep up with how much he eats, what his output is, etc. because they certainly do not keep up with that at home either. This is why they are in the hospital, so we can take care of them and get them back home. If we were not going to check these things, nurses would not be needed at all.
13. 
    Apr 2, '03

    I love this site
14. 
    Apr 2, '03

    I wish I had these responses at the time to further justify my actions

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