More Important?

suzanne4, RN · Nov 18, 2005

Many can have a pulse of 56, especially with all of the new meds out. Unless it is a neonate.

The bigger deal would be the 4 pound weight gain, but without knowing anything else about the patient, it is hard to say.

IcantThinkofaName · Nov 18, 2005

Pt with heart problems who is going to receive and antihypertensive drug.

HappyJaxRN · Nov 18, 2005

What should be reported first? Apical pulse of 56 or gaining 4lbs in 24 hours..

Yikes. :chuckle Is this a trick question? I'm just kidding. An Apical pulse of 56 isn't that bad. A lot of our transplant have pulses in that range, usually because of medications, such as CV meds or sedatives. When the pulse dips into the low 50's and below...I usually watch it a little closer and or start looking for other reasons...and reporting it. Er,um...weight gain of 4 pounds....This is important, but vital signs outWEIGH this. Pardon the pun. Um, I would be looking at how the person was weighed...was something left on the bed. I think too, looking at their fluid balance....increased edema, rhonchi....yeah, then this would be a problem...

I guess I need more information in order to answer this question.

HappyJaxRN · Nov 18, 2005

Pt with heart problems who is going to receive and antihypertensive drug.

No. I mean, YES! For a heart rate of 56, I would hold the CV med. The protocol on our floor is hold the CV med if the HR

IcantThinkofaName · Nov 18, 2005

:uhoh21: thats what i thought too!!!!! **pulls hair out** but wouldnt i want to report first if he has a significant amount of weight gain esp. that he has heart problems?:uhoh21: :uhoh21:

Cntw82BanRN · Nov 18, 2005

my opinion??? i maybe wrong but I think I would report the one who has gained 4 lbs in 24 hours because this could lead to fluid overload that can result in respiratory and cardiac problems if not treated or assessed right away. someone who has an apical pulse of 56 may not be that troubled unless other things are going on with this patient. Also it depends too on the age of your patient, and if the patient just recently took some medications that can lower the heart rate . I guess more info is needed to know exactly why these two patients have a weight gain and lowered pulse.

IcantThinkofaName · Nov 19, 2005

The question just says prior to administration of an antihypertensive drug what u report immediately?

it is definitely tricky and i picked 4lbs...

napoca · Nov 19, 2005

What should you report first? Priority question....You do not have any airway, breathing, but you have circulation (puls) . I will take the puls.

allnurses Guide · Nov 19, 2005

Personally I want to know if either pt is symptomatic...if neither is symptomatic I would report the wt 1st.

IcantThinkofaName · Nov 19, 2005

The question was definitely not clear. But its a question that has been on my mind forever. I can't emphasize what else was said in that question. it couldnt have been said any other way but yeah i chose 4lbs. i really badly wanted to pick VS because it was abnormal.....but 4lbs is really significant. omg just thinking about it lol:uhoh21: :uhoh3:

Cntw82BanRN · Nov 19, 2005

prior to administering antihypertensive drug?? well, I think it depends on the physician's order...if the MD says to report or withold drug if pulse is less than 60...then yeah I will report that. In our facility, we withold antihypertensive drug if the pulse is less than 50. Also it depends too whether the patients are symptomatic or not. If the patient who has a 4 lb weight gain and is showing respiratory compromise and cardiac symptoms, then this should be the priority ( correct me if I'm wrong but isn;t it if the patinet has fluid overload the patient will be hypertensive??)...In other words, this will require proper assessments.. I TOO WOULD LIKE TO KNOW THE RIGHT ANSWER TO THIS ( hey, it might be one of my questions when I take the NCLEX-RN)...He-he-he-he...