I held a lasix 20mg for a older gentleman whose bp was 82/50,I also noticed the bp was low 3 times that month, we are taking bps cause he has a low dose cardiac med which has bp parameters when to hold, but the lasix was given any way, I guess cause there were no bp parameters when to hold,I also know this person has fallen before, so I suggested to the md we have bp parameters to hold the lasix and got them.
Later in the day the HN informed me that the elderly dont take their bp at home before taking their meds,like lasix,so why do it at the hospital? and because the pt. load is so great on the floor and because taking the bp is time consuming and that the unit will be trying to eliminate orders to take bps and hence parameters on meds like lasix, and based on this information ,she instructed me in the future not to get bp parameters for meds like lasix.
The HN got abit irritated I gave her the rational why we should be taking bps on this patient,please note,Im not ragging on this HN,in most cases I have great respect for his judgment.
My question is...What is the most reasonable and prudent thing to do in this situation?
The patient has been admitted into hospital care for monitoring therefore as a professional I will continue to monitor my patient as I was trained [as a professional nurse] who by the way cares.
and because the pt. load is so great on the floor and because taking the bp is time consuming and that the unit will be trying to eliminate orders to take bps and hence parameters on meds like lasix, and based on this information ,she instructed me in the future not to get bp parameters for meds like lasix.
You got the order for parameters. That was the right thing to do.
Specializes in Med-surg; OB/Well baby; pulmonology; RTS.
You did the right thing.....
Let the HN go sit before the nursing board by not checking a BP before giving a cardiac med or Lasix......and an elderly patient goes KER-PLUNK on him.
I agree that patient safety comes first. The other night I checked blood glucose without an order (the MD ordered HS Lantus but only am blood sugar checks). Big deal, right? But to my surprise, a coworker questioned why I would do this. Well, sorry folks, but I don't ever give insulin without knowing a person's blood sugar!
;-( I don't need a policy to be safe and prudent! Policy isn't the final word. We are patient advocates, not robots running off hospital policy.
A few years ago, I refused to give an oral cardiac drug on the telemetry unit despite MD order because the drug book said it had a substantial risk of causing Torsades....not to give it without MD present (IN BOLD PRINT). I spoke with the pharmacist who hemmed and hawed over it,"Uh, he's a highly respected cardiologist, I don't know what to tell you."
I called the cardiologist and questioned the order.The MD said, "It's okay to give it without me." I told him it was not "okay" with me, and I wanted an MD there & the code team, etc! I did not give the drug. And the MD finally dc'd the order.
It's our job to question & make such decisions.
Remember, "First, do no harm."
You did the right thing!!!!!! Your HN needs a reality check.
you did the right thing! patient safety is utmost! does everyone find the same thing happening with digoxin these days, no pulse check because it doesn't get done at home! isn't it amazing though how much a nurse can pick up if he/she does the job properly.
You definately did the right thing. My question to your HN is, "If his bp is already low, why would I want to make it lower?" and "When he passes out and his head hits the floor, are you going to back me up in court?" Chances are that he will NOT! Remember, pt safety first because second is too late...
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ohbet
386 Posts
I wish I had these responses at the time to further justify my actions