New grad on cardiac floor just cannot relax after today

[justthatnewgirl]

Hi everyone! I graduated in May and started as a cardiac nurse in November. I have been off orientation since mid-January. I recently just started to not be extremely anxious all the time at work. However, today I had a patient that was going down to an angiogram due to some extensive blockage and a previous unsuccessful angio. As I am still not completely comfortable on the floor, I asked a more experienced nurse what medications I should and should not give the patient that morning. She stated that I should not give anything besides their aspirin, plavix, and beta blocker. As I was pulling the meds in the med room, I asked another more experienced nurse whether or not to give the patient their norvasc and/or imdur (I can't remember if this was the patient that had norvasc ordered). She said that I should since the patient was not to receive the angio still 1300 or later. So I listened to the second nurse and gave the medications. My patient went off to her angio and then apparently transferred to the ICU afterword which does not usually happen on our floor. I did not find this out until the end of my shift and never got a chance to hear why. I know that there can be complications that happen during angios, but I can't help wondering if something happened because of me. Plus, not knowing happened is really hanging on me. I am so anxious that I can feel my heart pounding and feel nauseous. Do you guys think that these medications would have messed up her angio? How do you guys deal with these types of feelings? If I could get some advice, that would be great. Thank you!

[Susie2310]

What were the physician's orders regarding what meds were to be given/held prior to the patient's angiogram?

[Cowboyardee]

It is unlikely that the ICU transfer had anything to do with you. Not impossible but unlikely.

That said, get in the habit of asking doctors for their pre-procedure orders, not fellow floor nurses. They both gave you bad advice. The correct answer would have been to check the orders, and if the orders don't have an answer for you, then call the doctor or the cath lab.

[NurseTrishBSN, CNA, RN]

Usually at my facility the cath lab will notify the charge nurse if a patient is not coming back so they can make plans for another patient. As far as the meds there should have been orders or you call and ask the cath lab or provider. Very few instances have I seen to hold meds for a cath.

[Wolf at the Door, BSN]

On 3/6/2019 at 9:13 PM, Susie2310 said:

What were the physician's orders regarding what meds were to be given/held prior to the patient's angiogram?

A real good experienced nurse would have guided you with that question not telling you what they thought was ok to give.

[cjl_RN, BSN]

If you ever question an order until the point where you ask multiple nurses get in contact with the physician performing the procedure or even the cath lab nurses. I worked on a cardiac floor and anytime I had an angiogram the only med I would hold is lasix. There are many reasons why a patient would have gone to the ICU after an angiogram a big reason is they left the sheath in. Only icu can have a patient with a sheath left in or another reason they went to icu is medication. The blockages maybe severe and they need closer monitoring. You can always ask your charge nurse why (they usually know) or the cath lab that not violation of hipaa. Don’t suffer yourself next time ask if you have questions. But trust me if it was becaUse of any medication you gave you would have already heard it from someone. Don’t worry about this. I remember being a new nurse and was always in a panic try to relax, especially on this situation. You’ll get plenty more worries throughout the years!

[cjl_RN, BSN]

Also I can give you some advice a lot of the nurses are saying check your orders and I am sure you did that. But reality is a lot of times the physician does not put in wether to give or hold, but they put the NPO after midnight order in which technically includes meds, but they are usually worried about the food for aspiration purposes. Meds are usually out of the belly within 30 mins- hour. You likely will always give the blood thinners especially plavix and aspirin. Plavix has to be held for a few days before it would even be beneficial to hold. Angiograms usually always give plavix its more of a risk if you hold it. It can clog a stent or cause clots by holding it and angiogram we want to keep the vessels open. Lasix a lot of doctors I’ve worked with want it held if you have a morning dose and morning procedure becus then the patient will have to keep urinating in the table. You ultimately want to do whats safest for the patient. Although those nurses experienced they can be wrong and saying nurse Kathy said it was okay wouldn’t hold up in court. But asking the doctor and then documenting a quick note what the doctor said will! The doctor would rather you reach him for a question than to make an error even if he does act like a dick he will hopefully learn to appreciate and respect you for that.

[offlabel]

Being unaware of circumstances or not knowing something is not an indicator that something is wrong.