Help with questions on meds

chillchick · Feb 28, 2010

With IV Potassium I would ALWAYS be thinking about the patient's current labs and monitoring VS and cardiopulmonary status due to the risk of arrhythmia. Also input and output because if it changes greatly from the previous day this could affect internal K+ levels, again creating a very bad situation! Irregular heart rate, WOB, SOB, change in skin color, changes in levels of consciousness are some things I would be looking for. Sorry if that is stating the obvious but you really have to be focused on those things when it comes to potassium!

That is correct regarding the insulin but try to be precise and not draw up too much.

Correct w/nitro and of course do not touch it! Also label when placed, initials, etc.

As far as who is responsible - what do you mean? Legally? Institutionally? I feel that one of nurse's primary responsibilities is being astute enough to monitor any and all changes in a patient's condition. Thus, I think a good nurse should be able to recognize an adverse reaction quite early and take measures to counteract it - thereby mitigating the issue quite a bit. Also it depends on the reason for the reaction - is it contraindicated for your patients, incompatible with one of their other meds, not the appropriate route of administraiton for your patient? Those things determine if it is your fault so it is always important to cross check orders before administering meds.

HollyHobby · Mar 6, 2010

Regarding IV potassium, the first thing is to check to be sure you have the right concentration and that your patient's lab results are compatible with giving supplemental potassium. Second, make sure you have a good IV. Third, keep on checking that IV; tell your patient (assuming your patient is conscious) to report any pain at the IV site.

As to your insulin question: throw out the syringe and start over.

For the NTG patch: you are correct. And chillchick's advice regarding wearing gloves, etc. is on the money.

As for adverse reactions, these cannot normally be predicted (unless of course your patient has a history of having an adverse reaction to a drug, in which case you probably wouldn't give it anyway). Side effects are to be expected, although some side effects are severe enough to make giving a certain drug contraindicated. For example, my son has severe itching with morphine. This is a common side effect, not all people get it, it's not dangerous, but it's certainly uncomfortable enough that my son shouldn't be given morphine.

Some adverse reactions are sudden, severe, and unpredictable. For example, I once had a patient who apparently had a massive stroke while on the commode after having coronary bypass surgery. But then she "woke up" and was fine. In very, very rare cases, Toradol (this is what this patient had received) can cause such a dramatic effect. The nurse would have no way of predicting such a thing (I have only seen this happen this once, thank goodness); it is not the nurse's fault when an adverse reaction occurs. The only important thing in this case is to recognize the reaction instantly and take appropriate measures as quickly as possible.

Every drug, from aspirin to TPA to tylenol has the potential of creating side effects and/or adverse reactions. The nurse's job is not to formulate the medication, but to try to prevent reasonably predictable effects and to take action when an adverse event happens.