lasix not given..

Nurses Medications

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Living now in rural Florida. Docs hear wont give more than 80 of Lasix a day and let Chf pts go home,. Had to go to 3 diff docs just to get lasix. Is there something i am overlooking or is this just the sticks. My client still inCHF help

Specializes in Med/Surg, Ortho, ASC.
My client wt is 300 lbs. She needs depletion....no risk of falls, etc, very strong

It still sounds as if you are pursuing your own idea of what is appropriate treatment for your patient - ie, diagnosing and attempting to treat by Doctor shopping. And you really should take your name off of your posts.

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Specializes in Family Practice, Mental Health.

What is the patients kidney function like?

What are the daily weights? What kind of trend have you seen in the past two weeks?

What is the I/O?

Does the patient get winded with baseline activity?

Please provide a clinical picture.

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Specializes in ED.

If she has CHF, and the doctors have treated her and she is still symptomatic, send her to the ER. It doesn't make sense to keep going back and going to more and more docs for CHF. Not like its sciatica or a muscle pull or something.

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Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

Your patient needs to 1) loose weight (I am not talking fluid weight either) 2) nitrates and ace inhibitors NOT MORE LASIX!

Feeding patients more Lasix isn't going to cure them of heart failure, but loosing weight will sure help! I am guessing if your client weighs 300 lbs it isn't all fluid! Talk to her about beginning an exercise routine, since you say she is "strong", she could probably start some exercise routine. Just walking would probably do her wonders!

Research is showing that Lasix is NOT the cure for CHF and that other medications, such as ACE Inhibitors and nitrates, and BP control are far superior in prevention of CHF than every day Lasix. 80 mg is absolutely a high dose in this day and age! We don't even carry it on the ambulance anymore! The thought process is that you are better off treating the patient with CPAP (or intubation in more severe cases) and nitrates rather than lasix, since they do not have an excess in fluid, it is just in the wrong places (the lungs or third space). Most patient's in CHF are in it because they spiked their BP, are having an MI (STEMI or non-STEMI) , or because they are in the end stages of heart disease, and their heart is not able to handle the increase in preload and afterload.

Another avenue to evaluate this patient's nutritional intake, especially with regards to sodium. Is she receiving meals on wheels or eating other foods that may be high in sodium?

Finally, you may want to check in with the hospitals in your area. The hospital I work in has a CHF clinic which closely monitors these patients and administers medications in order to prevent readmission for CHF.

Please do some research BEFORE you start recommending high doses of a drug that causes more harm than good!

Annie

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Specializes in CVICU.

Have you tried asking these doctors why they think an increase in Lasix is not the best option?

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Specializes in Cath/EP lab, CCU, Cardiac stepdown.

Have you taken a look at their electrolytes or their kidney function? Do you know what lasix does besides getting patients to void? Are they getting some other type of diuresis? And heart failure is basically for life but just requires management. They're not going to cure their heart failure. They manage any acute exacerbation of it and then send them home.

Your patient should be doing daily weights and notifying their pcp if they are having excessive weight gain or edema. How are their lung sounds? What's their usual weight? Creatinine? Bun? What other meds are they taking? How bad is their edema 2?3? Etc. just because something is the mainstay treatment in managing a disease doesn't mean it's all cookie cutter clear, you have to look at the patient as a whole rather than just a disease process. There's also fluid restrictions and sodium restriction diets for management.

Really, OP as nurses we should stay away from the image of just being pill pushers. We should show some critical thinking and stay away from just saying they have chf and need lasix. State their diagnosis, their symptoms/ your assessment, what your plan is and why/how the patient can benefit from it. If the doctor doesn't respond to your request when you present in this manner then you should ask them why so that they can explain their thought process and plan. We are not educated like a doctor so if there is something you don't understand, ask them after you let them know what you were thinking and then they might educate you on what they want done.

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Specializes in Hospice.

Here's a thought-not a nurse, but the patient herself.

There's absolutely no critical thinking being displayed here, but plenty of "this is what was done before, needs to be done again, will go to as many doctors as necessary until I get what I want."

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Lif I dont know what is appropriate for my patient after 35 years of nursing, THEN something is wrong. Just because some M.D. wants to polish his acedemic credentials by publishing some unfounded new theory doesnt mean i have to go along with it. Want to see a drop in BP? Give IV phenergan too fast. No, the benefits of lasix therapy outweght the negative. Stood by too mant chfers bedside for that. Brst go see max safe dose in the PDR. Dont believe every new trend that comes along.

L

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Specializes in Cath/EP lab, CCU, Cardiac stepdown.
Lif I dont know what is appropriate for my patient after 35 years of nursing, THEN something is wrong. Just because some M.D. wants to polish his acedemic credentials by publishing some unfounded new theory doesnt mean i have to go along with it. Want to see a drop in BP? Give IV phenergan too fast. No, the benefits of lasix therapy outweght the negative. Stood by too mant chfers bedside for that. Brst go see max safe dose in the PDR. Dont believe every new trend that comes along.

L

In your 35 years of nursing, in what point did it become acceptable for you, as a nurse, to decide what is more beneficial than harmful in terms of prescribing medication for your patient? That is not your scope of practice. There's a difference between trends and scholarly published articles. Evidence based practice dictates that we go with what is researched and not what has always been done that way.

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Have you tried asking these doctors why they think an increase in Lasix is not the best option?

This!!!

Often times we nurses get things in our heads and want what we think is best. Working in LTC, we do a lot of suggesting to the drs since we are the ones assessing and calling them MD. If I really think they need XYZ and the DR denies the request, I'm always willing to be educated.

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Specializes in Critical care.

OP, you asked a question, others have asked further questions to help arrive at answers, but I'm not seeing you respond?

If you are this rigidly insular in your interactions with providers, then perhaps this is why you aren't getting the results you expect?

No give and take, ya dig?

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Specializes in Oculoplastics.
You need to look at the latest research, most of which says we have been killing our patients with excessive lasix rather than helping them!

Annie

Do you have any links for this research? I would like to look into this. Or at least point me in the right direction?

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