IM and PO Lasix together?

[missourinurse2b, BSN, RN]

I have experience in both acute and LTC but admittedly, I have been out of long term care for some time and just now started a job at a SNF. I questioned an order that the doc wrote...resident receives PO lasix 40 mg daily but doc wrote for IM lasix 40 mg daily X 3 days due to increased edema. The other nurse who has been at the facility for several years knows the doc well and said that is what the doc ordered at rounds and his written order did not say to hold the PO lasix but I clarified it anyway. Apparently this is something he does....anyone else have this to happen? I give IV lasix in the hospital setting and have given lasix drip even but this order just seemed strange to me.

[amoLucia]

Just trying to think this out --- pt would be receiving 40 + 40 Lasix to total 80 mg. That is an occ ordered dosage particularly for someone needing strong diuresis.

Seeing that it is a time-specific order for only 3 dosages, I could go along with the idea that it was intended for a short-term boost-type of diuretic management.

Remembering that I'm Lasix is stronger than PO, but less than IV also makes sense considering the pt is LTC and plain old 80mg might just not be strong enough or fast enough to get the pt controlled.

Similarly, I've seen orders for digoxin 0.5mg given in lieu of 0.25mg for a one time dose to control an arrythymia (old time doctor with old time pt with old time dx).

In LTC, IV drug approach may not be a reasonable approach, so the next best thing is utilized. Hence, the I'm.

Makes sense to me.

You did right to clarify it though. I would have done so also as it was not a typical order.

[BSN-to-MSN, ADN, BSN, RN]

I M not I'm. Darn auto corrector is not a nurse.

So glad you clarified. The I M is appropriate due to the setting - there are no IVs in the long term setting.

[Tenebrae, BSN, RN]

Not uncommon where I worked.

A patient could be on a set amount of lasix and would be given an increased dose for a set period of time to see if the excess fluid could be moved