Nitroglygerin

It may be part of a chest pain alert protocol and therefore you would have a protocol based order. Otherwise I would not give it.

It's possible that the lack of an order for nitroglycerin for chest pain is intentional, nitroglycerin is contraindicated in ischemia involving the right ventricle. It could also be that the ordering MD did not order it because the patient takes a phosphodiesterase inhibitor that you may not be aware of. I would be careful about first investigating why it isn't ordered since there may be a good reason why it shouldn't be given.

I just love the misspelling in my title :) A lady recently had an acute MI, paramedics came, did CPR for about an hour. She died immediately. She was complaining of chest pain shortly before. I was on the next hall over, but I look at the meds everyday and she didn't have an order for Nitroglycerin, as this was an acute attack. I'm almost positive the nurse didn't give it.

I would not give a patient nitro without an order. In a hospital setting, I would call the provider about an order while getting an ecg. In a community setting, I would also call 911 when the patient started to have her acute attack. I do not think you can attribute the patient death to the nurse not giving the nitro.

I know EMS will administer nitro unless contraindicated but on the floor, this is a no-no. In fact, there is not a single thing we can or will give without an order at my facility, especially nitro. I work on a cardiac floor and when I first started after a few years of being a tech in ER, I asked this exact same question and my manager looked at me as if she'd seen a ghost. I couldn't fathom why giving a chest pain patient, especially one with a cardiac history, an un-ordered nitro would be a bad thing.

If someone is having chest pain, I assess the patient, get a set of vitals, and sometimes will grab an EKG (even without an order) while I have a page/call sent out to the provider. If you make the mistake of giving a nitro in an inferior MI, your patient's pressure will bottom out (loss of pre-load) and you will be up poop's creek; this is why EKG and provider recommendation are paramount.

Not only do you not give Nitro without an order, don't give ANY med without an order.

It could be a direct order from the MD or a Medical Directive, but it has to be ordered before it is given.

If it's not "ordered", don't give it.