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CVARN's Latest Activity

  1. CVARN

    Can an old dog learn new tricks?

    Hey, I am wondering if you all think (at age 54) I am too old to move into L&D? I have been working as an RN on a busy neuro/cardiovscular/step down unit for 11 years, and I am thinking it might be time for a change.
  2. CVARN

    blood pressure drops after dialysis

    Update: I spoke to management yesterday, who support my actions 100%, and will be discussing this (as well as many other issues) with the MD. Thanks again for all your input.
  3. CVARN

    blood pressure drops after dialysis

    To be honest, the more I thought about your post, the more shocked I become! It is very different, indeed, to be a nurse in California, at least in the facility I work in!
  4. CVARN

    blood pressure drops after dialysis

    Thank you for all your responses... What I m understanding is that in most of your hospitals, there are parameters written for when to hold blood pressure meds, especially for hemodialysis patients? hmmm... what a luxury! I have never worked in another facility, and the hospital I work in relies heavily on nursing judgement (with the exception of this new doctor). I believe many of our MDs would think we had lost our minds if we called to ask for parameters! For the record, my patients are dialyzed bedside, and of course I consulted with the HD nurse, who told me she usually doesn't advise medicating for at least an hour after HD to give the BP a chance to stabilize. Anyway, thanks again.
  5. Hi, and thank you in advance to anyone who attempts to help me with this... I am wondering what the standard is with regards to medicating dialysis patients during and after hemodialysis. I had a patient whose SBP just over 200 in the morning when I came on (and was apparently this high for the previous few hours). I immediately gave her am meds which brought her BP to the mid 180s (no PRN meds had been prescribed), and doctor was advised. Later that morning, she was dialyzed. During dialysis, she had one episode of emesis (per the HD RN, she felt is was related to the drop in BP). She was still being dialyzed when her 1400 dose of hydralazine was due, so I held it, assuming it would dialyze out. I waited about 30 minutes after dialysis to check her BP again, which was now down to 117/--. Because she threw up due to a blood pressure drop, and because there was such a huge difference between pre and post dialysis blood pressure, I decided to wait a while before giving the hydralazine (which I eventually gave at around 1730). Primary MD later complained that I should never have held the hydralazine. So my questions are these: do you give BP meds during dialysis? Also, do you worry about bottoming out a patient's BP by medicating immediately after dialysis?

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