New grad-still wondering when to hold certain meds!

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I'm a new grad working on a med-surg/telemetry unit. I've been taken off orientation and have been working on my own for about a month. When a new patient is admitted, a formal med sheet is not printed out for them and there is generally a hand written one by the unit clerk. I am always a little bit iffy on when to hold certain meds and when to give them. The other day, a bunch of the nurses were picking on another new nurse for holding lisinopril for a pulse less than 60. I know that generally you would only hold that drug for a low BP (less than 100 systolic) rather than a pulse. But it made me think! The other day, another nurse was giving Procardia. She gave it to a patient with a heart rate of 50. I thought that you should hold this drug for a HR of less than 60 and systolic BP less than 100, but I'm really not sure! What about Cardizem? Hold for a low BP, low pulse, or both? Just wondering if anyone has any info on BP/pulse affecting drugs! Wish I had one of those drug books for nurses to tell you when to hold and when not to!

Also, insulins...I know everyone's blood sugar differs and insulins affect people differently. But at what blood sugar would you typically hold Regular Insulin or other types of insulin? I just started working nights, if a patient has dialysis in the morning, do you hold ALL of their meds or just certain ones? That's a lot of questions for one night...thanks!! :)

In my facility, physicians always give a parameter; if not, the pharmacy will call them. How I judge should I hold meds is that I will recheck the BP and Pulse for one full min. Making sure that I double check and obtain the accurate data; and maybe ask charge nurse or preceptor cause they are enrich experiences. I don't see any problem if I make it carefully.

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play Post Office

A good name for a terrible game !

OP, I like the Davis drug guide. My other suggestion would be to start making notes of the meds you've seen during the day. Categorize them into how they effect BP/HR/etc, and how you've seen them used. Probably not the easiest answer I know :)

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Specializes in neuro/ortho med surge 4.

If there are no parameters on BP meds I call the MD and ask if I should hold or not. Then I ask for parameters. Patient is not harmed, MD has information on patient having a soft BP, and I have covered my self.

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We must also contact the physician immediately if a patient refuses a med, and obtain an order as to what the physician wants done.

I missed that line when I saw your post the first time. I honestly can't imagine having to call the doctor every time a patient refuses a med. Our physicians would spit kittens if we started doing that!

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Specializes in ER, ICU.

If you don't have it, get Epocrates for your Palm or iPod. I swear by mine. You can get a cheap Palm Pilot for about $100 I think. This will tell you the exact mechanism of action of a drug in seconds (and cautions and adverse effects). A bet blocker has much more effect on HR than BP, for example, so that would be the parameter to watch. You can also check to see what the patient's VS were when the drug was last given. Hopefully the provider gave parameters. It takes time to get a feel for how certain medications work, always think safety and ask for help.

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Specializes in ER, ICU.
All of us nurses on the unit I work on are currently on a "plan of correction." This is because a state surveyor found that nurses were holding meds with no written parameters based on the nurses experience and education. The surveyor stated that this is practicing outside of scope. We must contact the doctor immediately and get an order from them as to whether to hold or not. For example, if we get a BP of 89/59, we cannot decide to hold the med on our own, we must obtain an order from the physician. We must also contact the physician immediately if a patient refuses a med, and obtain an order as to what the physician wants done. We had been making these decisions on our own and letting the doctor know in the morning, but this is not acceptable according to the surveyor. So we have been trying to educate our physicians to write parameters on their orders if they don't want to get several phone calls every day. They are loving this new policy--not. And I guess I've been practicing out of scope for years!

I thought that "don't kill your patient" was a standing order :lol2: It would seem that the facility medical director could write standard parameters for common meds, and docs could write their own that would override the standard ones when they chose.

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Specializes in Trauma Surgical ICU.

Yeah, we gotta love the whole "nursing judgement" and "critical thinking".. I thought that is why we went to school and learned the "safe" things to do and not to do while giving meds.. But our thinking legally only goes as far as knowing it is not safe and call the DR.. we can not decide not to give a med without a doctors order..

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Specializes in med/surg/tele/neuro/rehab/corrections.

Recently had a patient with HR in the 40's from metoprolol. Didn't get that in report that MD was aware and gave Doc a call. Glad I did. Doc stated was aware and go ahead and give med. Got to chart that. Patient had been in the 40's for several days. I was in a panic when I looked on my computer and saw that! Metoprolol can cause heart block and bradycardia. Really learned that day just what the adverse affects were!

It was a good learning day for the students who were on the floor. We all discussed it with their instructor and I bet they discussed more after clinical. You know these things are such a big deal to students. They will talk about it until they graduate LOL :D

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Omg...all of these questions/answers are so good. I am a new grad lpn and just got hired at a LTC facility after looking diligently for 9 mths after passing boards. I am really greatful for this site because it will help me know what to do and not to do as a new nurse. Thanks everyone! I hope I am able to ask you all any questions that I maybe unsure of without being belittled. Have a wonderful day! :-)

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Omg...all of these questions/answers are so good. I am a new grad lpn and just got hired at a LTC facility after looking diligently for 9 mths after passing boards. I am really greatful for this site because it will help me know what to do and not to do as a new nurse. Thanks everyone! I hope I am able to ask you all any questions that I maybe unsure of without being belittled. Have a wonderful day! :-)

OMG! I hope you're not using posts from strangers on the internet to decide when and when not to hold medications! I hope you're not going to be taking clinical advice from strangers on the internet who may actually BE nurses, but who may also be trolls. Surely you have some legitmate reference materials at work, and a preceptor or charge nurse to help you figure things out.

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Ruby Vee,,, of course not I have studied and worked my butt off to become a competent nurse. I like the fact I can come on here to get an idea what I need to look out for and with no hesitation to ask a question to my preceptor when need be. I do have references to drug books/literature. I like to read what other experienced nurses has gone through so I won't make those same mistakes because I know we all do at some point in our career. Thanks for your input. I appreciate it.

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for dialysis patients, if they have an early morning dialysis appt I tend to hold all their meds. if its later in the morning or afternoon I generally will call either pharmacy or the dialysis unit to ask which specific meds I should hold.

for bp meds like ace inhibitors, I hold bp meds for low BP generally

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