IV bolus to CHF patient. Need your opinions please

[lsvalliant]

Im a home health nurse and got orders today by a primary doctor to infuse 1 Liter of LR with 20meq K over 3-4 hours every day for 7 days. This pt has CHF with +4 pitting edema and SOB with mod exertion. I refused to give it and consulted her cardiologist who agreed with me. The primary MD states the cardiologist doesnt know whats going on and pt needs the fluids based on the labs. Whats your opinions? I'm still refusing to carry out the order. What do you think?

[Altra, BSN, RN]

As a couple of people have pointed out, edematous does not necessarily equal fluid overloaded. Yes, more specific data about lab results is needed to evaluate this order, but it doesn't necessarily seem totally off the wall to me. One liter over 3-4 hours is not particularly aggressive.

I have the same questions as you all: renal function, lung sounds, albumin/pre-albumin status, how is the p.o. intake, etc.

What I'm saying is ... you can't just say, no fluid boluses for a CHF patient. CHFers, even edematous ones, can be "dry".