I have been coming to this site for help with "how to" do nursing in the "real world" and so far this site and your responses have been a pot of gold for me...and, again, I have "burning" questions
1. Lets say your on days...you get an admit at about 1600, shift finished at 1930...you do your admission, he is admitted for a hernia operation that has become infected, pt with BP of 165/86, hx of HTN, you check orders and give the antibiotic that was on admission orders, no other meds ordered at 1600 except the antibiotic, and make a mental note to tell the MD, who is coming into assess the patient, about his BP....so MD doesn't come in untill 1800 and you don't get the new orders he has ordered until 1830.....and they look like this..
metoprolol BID
norvasc Q AM
filodipine Q AM
aricept Q AM
The only med the patient has taken today is his metoprolol in the morning
Do you give the AM meds at 1830?, and of course give them in the am the next day, or do you just give the metoprolol at 1830? and then give the AM meds the next day?...MD doesnt answer page, you have a hundred other things to do before 1930 and you have to use your nursing judgement
I would give the Metoprolol and hold all the other meds til the am. You can give more meds if needed easier than you can fix a bottomed out BP. I would inform the night shift that you tried to reach the doc but couldnt get him. If the BP goes up or doesnt come down on nights, they can call and get a PRN of clonidine or something like that. I have found it beneficial to have prns available even with pep on a lot of BP meds because they just take the meds and maybe check their bp once a day if that. We check it very often and we need to act on it if its too high. I wouldnt give them all at once because you dont know how it will affect them, seeing that this is a new pt.
Our schedule for BID meds here is 1000 and 2200. Aricept is not a b/p med. His b/p is 155/86 so it is running alittle on the high side and will probably creep up higher as the night goes on if he is without his usual meds. If you are sure he didnt take them at home prior to admission I would give the two meds for b/p and the aricept that he takes daily at 1830...the lopressor at 2200 unless his SBP is
Maybe I did not give you information about the exact name of the drugs accurately, I don't remember the precise names of the meds....my point was that they were BP meds and the times that they were to be given were in question...but your question certainly shows your sharpness and critical thinking, something I wish God provided me more of...which is a big part of my problem.:bowingpur
Let's say a patient goes to dialysis in the morning....am bp meds are held...and sometimes nurses hold all am meds....when the patient returns, say around 1130, would you call the Dr. and ask if he wants the patient to recieve the am meds that were held? After all it is no longer in the am.
I was re-reading all of the answers to my question and was struck by the differing opinions....I guess there is no reliable standard on which to base a nursing judgement in this case.
I would give the meds at 1130 after dialysis. I frequently have patients that are NPO for a test or just off the floor for tests and am meds have to be given at lunchtime.
Absolutely, I would check the BP first. I just meant that just because daily meds weren't able to be given at 10am doesn't neccessarily mean you shouldn't give them.
RosalindRN
43 Posts
I would give the Metoprolol and hold all the other meds til the am. You can give more meds if needed easier than you can fix a bottomed out BP. I would inform the night shift that you tried to reach the doc but couldnt get him. If the BP goes up or doesnt come down on nights, they can call and get a PRN of clonidine or something like that. I have found it beneficial to have prns available even with pep on a lot of BP meds because they just take the meds and maybe check their bp once a day if that. We check it very often and we need to act on it if its too high. I wouldnt give them all at once because you dont know how it will affect them, seeing that this is a new pt.