I need help.........

beausud · May 31, 2004

Can I d/c a IV NS Bolus without a Dr. order?

hmmm.. ok is it negatively affecting the patient? lungs clear? vital signs stable? why was the bolus ordered in the 1st place? why do you think the bolus needs to be stopped? what do the most recent blood work say? these are some questions that the MD might ask you. what do the senior RN's on the floor think about this? im sorry to have to answer your question with MORE questions...if it were me and my patient is not tolerating the bolus, i would stop it and call the MD. look out for your patient, if the MD pulls a tantrum... he/she'll get over it; as long as you have a valid reason for your concern. i hope this helps.

GingerRN · May 31, 2004

Thanks for responding....yes...neg affect...pt presents to Er in resp. distress..v/s 97.7 ax, 94, resp 30 rapid, shallow and labored, bp 135/52 spo2 89% with Alb/atrov in progress. audible rattling-lungs diminished in lower lobes with scattered rhonchi throughout bilat. rattling clears with cough after tx. O2 15L/min NR...ekg, abg, lab, pcxr all ordered...pt pale, not cyanotic on arrival, no JVD, no dependent edema. Sinus Tach on Ecg monitor. Pt A/O x 2. Vague hx...only "recent sore throat with cough...weaker the last two days", and "diabetic..she takes glucophage", and "had an MI in 1989"...that's all I got from pt, family, and EMS......I tko'd the NS....but, I am being questioned why I didn't dc it. They way I look at it I need a Dr order to start it....I need one to stop it. Oh...and the Dr was there. Am I correct? Did I need the order to dc? The NS was initiated by EMS.

Trauma Columnist · May 31, 2004

In our ER - we as RNs can use clinical judgement to convert the IV to a saline lock. That's what I would have done. Do you have protocols or standing orders in place? Now, might be the time to do this.

SWFlorida · May 31, 2004

In our ER - we as RNs can use clinical judgement to convert the IV to a saline lock. That's what I would have done. Do you have protocols or standing orders in place? Now, might be the time to do this.

I agree. This patient didn't need all that fluid running in. The line should have been switched to a saline lock. The only way the dr would have a fit is if the entire IV site was dc'd. A quick "hey doc, do yuo mind if I heplock this site" would have covered you.

z's playa · Jun 1, 2004

I was admitted to a medical floor and the doctor ordered NS/IV. Well it was 1 week and the order still stood along with the pain meds. I was so bloated...well I was so bloated. Thank gosh the nurses stopped the IV and notified the doctor the next morning on rounds. I would have blown up ! :chuckle

veetach · Jun 1, 2004

Can I d/c a IV NS Bolus without a Dr. order?

In our ER the nurses rely on their nursing judgement, and then we just let the docs know...