For a single patient, I've seen two different decisions (one held, the other did not for a BP in the same range) by two different nurses on two different shifts without a corresponding change in patient status.
I realize I might be missing a bigger picture of the patient and your answers might consist of "Well, it depends on this, this, and this...there isn't a hard and fast rule." In fact, I hope I get answers like that to help me see more so that I can apply it to future patients.
Specializes in Professional Development Specialist.
I have also called Drs and asked for parameters. I work in a practice that requires a lot of autonomy but I don't make that decision on my own. My cohort was hold Lasix for low bp, but the pt has in acute CHF. I talked to the md and an RN supervisor I trust. The pt was running super low bp but in an acute CHF exacerbation and after lots of careful monitoring she tolerated the Lasix with almost no change in her BP. Sometimes the benefits of Lasix is more important than a potential BP drop. The Md should be able to give you appropriate parameters for each patient.
I agree you should call the doctor before withholding lasix. Have pertinent info ready, such as lung sounds (rales?) intake/output, last potassium level, etc., ready when you call. Lasix is not a drug you would withold simply based on a blood pressure reading.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
You have recieved some very good advice. How does the patient look.....is this odd for THEM. But always call them MD to let them know of your concerns and if there are any other orders.....:)
i see mentions of electrolytes and potassium, but i'm not sure the op has a functional handle on this.
lasix makes for potassium loss, and fairly promptly too. someone with a bad heart may have increased myocardial irritability from a variety of causes-- hypoxia, infarction damage, metabolic imbalance, trauma--, leading to arrhythmias. low serum potassium makes this more likely, since it increases the loss of intracellular k+ across the cell membrane and thus decreases the depolarization threshold. when cardiac myocytes depolarize without being asked by the normal conduction system, pvcs result. more pvcs, multifocal ones because now more of the myocardium is irritable from the low k+, are a bad idea. (risk for inadequate perfusion related to electrolyte imbalance and prior myocardial damage)
when i worked cv, we kept our patients' k+ at 4.0-4.5 (via frequent checks and iv supplementation on a sliding scale) for this reason. for some people, sliding down to even a low-normal-range 3.6 is an invitation for more pvcs and increased risk of vt. so the nursing intervention is this: if your assessment finds the patient has a k+ of 3.1, you might want to be sure he gets his potassium replacement awhile before his am furosemide; if he isn't ordered for potassium replacement, ask why, and see if it was just an oversight. and heck, who wants to disrupt her whole workday with a code, anyway?
this is one reason you check your patient's labs first thing in the morning :)
I also like to consider who I am giving the lasix to.
The post CABG with the EF of 35-45% with the BP of 92/42 and HR 118, I would call the MD and clarify. 99% it is held.
The acute on chronic CHF EF of 15% on milirone gtt at 0.375mcg/kg/min with the BP of 84/44 HR 78, 3-4+ BLE edema, whose baseline BP is normally is the 80s and is on the transplant list. Yes I will give the lasix, unless pt's creatinine has spiked from the day before. Frequently we have pt's on lasix gtt's with SBP's in the 80-90's.
The answer is not clear cut. But Obv if you feel the pt is hypotensive and symptomatic, you should prob hold it and tell the MD and see if they still want you to give it. It's going to drop their BP...it's a Preload reducer and dilator. A lot of CHF pts need to live with a lower BP....the higher BP just puts more strain and added load on their already poor pumping heart. But go with judegment and clarify with the MD first.
JenniferSews
660 Posts
I have also called Drs and asked for parameters. I work in a practice that requires a lot of autonomy but I don't make that decision on my own. My cohort was hold Lasix for low bp, but the pt has in acute CHF. I talked to the md and an RN supervisor I trust. The pt was running super low bp but in an acute CHF exacerbation and after lots of careful monitoring she tolerated the Lasix with almost no change in her BP. Sometimes the benefits of Lasix is more important than a potential BP drop. The Md should be able to give you appropriate parameters for each patient.