"What would you do" continued....

Tait, MSN, RN · Feb 10, 2009

Are these meds the patient normally takes at home? If so I would ask him if he took them today. If not I would most likely give them, or if the night shift is there I would ask them what they would like you to do (considering they have to deal with the ramifications if his BP drops.) If he can't tell you (i e dementia) then I would chart them as not given as unable to verify pt previous dose for the day (well aside from the BID Meto).

More of my judgment would come from the "amounts" the patient is on. If its a ton of Norvasc + like 50mg of Meto then maybe you could give the Meto and leave the Norvasc for nights to use if they need it. (i.e. his BP starts to creep)

It's hard to tell from a written distance the exact path I would take, but that is a little of the thought process behind decisions I have made in similar circumstances.

Best of luck!

Tait

floatRN · Feb 10, 2009

My hospital has a policy about this. If its a daily med and its more than 12 hours until the dose would normally be given, you can give a dose now. If its a twice a day med and its more than 6 hours until the scheduled time, you can give a dose now. So, I would ask the patient what he took at home that morning and if he didn't take his daily meds, I would give them then.

garciadiego · Feb 10, 2009

FloatRN

Wow, so you would have given those am meds at 1830, that's interesting..I asked 2 nurses on the floor about what to give and they both said just give the eve metoprolol....I really have no idea of what to base their decision on, nor what to base my decision on, since we have no policy, like you do at your hospital, on which to base a decision.

eriksoln, BSN, RN · Feb 10, 2009

I'd be willing to be there is a policy. Do some searching for it. You'll be glad you did if you find it. I am surprised at the things I find policies for sometimes.

I would only have given the metoprolol though. Thats me. If I felt I did have to give any of the other meds, I might avoid the norvasc. IDK, that many anti-hypertensives so close (casue he'll get another in the morning). But, again, thats me.

Like others said, its hard to tell from a forum description of the situation. The first thing I would question is if you believe the pt. about what they took or not. There is AOx3 pts. who just are......forgetfull. Lots of people cant really recall well what they took a few hours ago. That'd be a primary reason I'd avoid giving all the other meds, uncertainty of whether they really took them in the AM or not.

Christie RN2006 · Feb 10, 2009

Usually our docs will write if they want us to give a dose now, for example they would write... norvasc first dose now and then Q AM

Based on the orders, I would only give the metoprolol, but I would probably ask the doc what they would like to do because then you cover your bases. If the doc says not to give the AM doses now and his BP goes high or if the doc says to give the dose and his BP goes low, you can't be blamed.

DeepFriedRN · Feb 10, 2009

Based just on the written orders, I'm thinking you'd only give the metoprolol. That said, if the patient hadn't taken the q am meds, I also think I'd call to MD to see what he wanted to do. Because from the looks of it the pt's BP could creep up, and he's probably on that many BP meds for a reason.

RedCell · Feb 10, 2009

Why is the dude on two dihydropyridines?

garciadiego · Feb 10, 2009

Thanks all

Thats two for metoprolol....I think technically if the order says am then it is am, unless dr. writes give now as Christie indicated.

RedCell..two what?

RedCell · Feb 10, 2009

Thanks all
Thats two for metoprolol....I think technically if the order says am then it is am, unless dr. writes give now as Christie indicated.
RedCell..two what?

There are three seperate classes of calcium channel blockers...

dihydropyridines

phyenylalkylamines

benzothiazepines

Each subclass works slightly different to achieve its desired effects.

Felodipine and amlodipine are both dihydropyridines. Drugs that cause vascular smooth cells to vasodilate through modulation of L-type calcium ion channels. Both drugs do the same thing.

I would want to know why it was necessary for the dude to be on both drugs?

RochesterRN-BSN, BSN, RN · Feb 10, 2009

The BP is not that high so just the BID med--the metroprolol would probably be sufficient and give the others as ordered......I do tend to make sure to talk to the doc because I have had them, based on what the BP is do things like give some but not all, or give half the dose of the am meds just for that one time.....they want to know the pulse too though usually so they can decide what to do. Do you not have residents or PA/NPs that cover for that Doc after he leaves that cover just to ask a basic question like that? We used to use these people for this often. It would cover us but not bother the doc and they were usually happy with the decision the res/pa/np made.

litbitblack, ASN, RN · Feb 11, 2009

If they are his daily meds and he only took one then I would give them because he hadnt had them. His bp is prob up because he didn't take them.