Parameters and trends

Hello,

I am a nursing student, and we are beginning to cover specific medications. Is there a source I can use to find specific parameters for classes of medications, such as insulin, vasodilators, opiates, etc.? I've tried searching through my drug books, but they don't seem to give actual parameters of when to hold or give a specific medication. I know people say the doctor who orders the medication will give written parameters, but as a student, I am more just trying to learn the general parameters for classes of medications!

Any help or advice where to look would be greatly appreciated!

Thank you!

You will not find vital sign parameters in drug guides. Why? The drug guide is about the drug, not about the patient. A heart rate of 40 may be life-threatening in an 80 year old woman taking beta-blockers. Or it may be perfectly normal in a 25 year old athlete. The drug guide, nor any other source, can give numeric parameters for giving or withholding a drug. Only a physician with knowledge of the patient can do that.

You'll be much better served studying the mechanisms of action and the contraindications for medications rather than looking for specific numbers. Numbers you have to memorize. By learning how the drug works, you'll be able to identify situations where it may not be appropriate to give it. It will give you a much more comprehensive understanding and make you a better nurse. Let me illustrate the difference.

A. "Don't give metoprolol if the patient has a heart rate less than 50."

-Great. Now you know one specific fact about this drug. Do you have any understanding about WHY you shouldn't give it for a heart rate less than 50 or how it works? No. So you decide to dig a little deeper....

B. You learn that that metoprolol is a beta-blocker. Beta-blockers are also called beta-adrenergic blockers. What's that? You find out that beta-adrenergic agents are part of the sympathetic nervous system. You remember from pathophysiology that the sympathetic nervous system is the "fight-or-flight" response that prepares out body for emergencies. You learn that adrenaline is a beta-adrenergic agent. When the kidneys release adrenalin, it causes that fight or flight response. The heart rate increases and the blood vessels constrict. Metoprolol blocks that response. It keeps the heart rate from increasing and the blood vessels more relaxed. You also remember from pathophysiology that blood pressure is a measure of the force that the heart has to use to push blood through the veins, and so when veins are more relaxed, blood pressure is lower.

Now you know how metoprolol (actually all beta-blockers) work, and what effect they have. So if your patient has a history of hypertension, you now know why they have metoprolol ordered, and if your assessment reveals a low heart rate or a low blood pressure, you understand why it might not be a good idea to give this drug.

See the difference? By focusing on how the drug works, you'll learn both why it's needed and when it might be unsafe to give it. You'll learn much more than you will by just memorizing certain parameters.

I'm also not entirely clear on what you're asking. Parameters are included in the physician/provider prescription to indicate when a medication or treatment could be held (not given) or given. Esme gave you the example of digoxin.

Trends, as I understand you might be asking, are directions in which measured data are moving, for example: BP is trending down, meaning that it's been decreasing over time. Or heart rate is trending up, for example. Or urine output, endurance, or anything else you can measure.

If i understand you correctly, you want to know if / how these might intersect. I'd say that while parameters are givens (specified), trends are revealed as the result of acquiring assessment data. So you might notice that a patient's heart rate is trending up and his urine output and BP are trending down, and that should make you think of some kind of heart failure. You would notify the prescriber (NP or physician) of these trends to give them data upon which to base a medical plan of care.

Or you might know that the desired or expected result of a particular part of the medical plan of care is X, and you might look for patient assessment trends to see that it's being effective or not.

Or you might know that a side effect of some part of the medical plan of care is Y, and you might keep your eye on patient assessment trends to watch for that.

Does that help?

Good example. One small cavil: the adrenals, not the kidneys, are the source for adrenalin (catecholamines).

Absolutely the reason why you want to have a really good handle on physiology. If people had normal physiology we wouldn't have to take care of them because they wouldn't (usually) be sick. But pretty much everybody has some sort of physiological derangement, even if it's temporary (like a fever), so having a good working knowledge of normal physiology gives you the way to understand what's wrong when you study pathophysiology.

Good example. One small cavil: the adrenals, not the kidneys, are the source for adrenalin (catecholamines).

Thank you for the correction. Yes, the adrenal glands, which sit on top of the kidneys, produce the adrenalin.

Superb explanation. Thanks for making it clear that nursing is about THINKING and using information, in context, to address patient problems.

Memorizing will only get you so far. To excel at Pharm, you must understand the drug and then think through the implications of that.

Thank you for your responses! I've taken pharmacology and understand how the medications work, but this will be my first semester of actually passing meds. I will hopefully get the chance to see the parameters the physicians write so I can see this in practice. I appreciate all of you explanations!

If you have the money to spend, download the skyscape application on your phone and get the Davis Drug Guide and Intravenous Medication Guide. Skyscape Labs is also helpful. This was a required resource for me during nursing school. It was very helpful to be able to pull my phone out and read basic information on a drug regarding assessments, mech of action, contraindications, rate of administration, etc for a drug I wasn't familiar with. Now, for the very common drugs, you'll have an easier time memorizing this information. For example, my new job is on a cardiac/neuro telemetry unit. Chances are, I will be most familiar with the cardiac drugs than I would be with chemo drugs. Basically, if you work on a certain type of floor, you'll see a lot of the same drugs every single day. I've given furosemide (Lasix) and diltiazem (cardizem) more times than I can count.

There really isn't one single answer to your question as there are many, many drugs and each patient has a unique situation. Make sure your assessment skills are on target and go from there. Ask yourself "What does this medication do, how will it benefit my patient, and what do I need to look for?". If ever in doubt, consult a drug guide. Do not overwhelm yourself and try to memorize everything all at once.