I'm a 2-year old nurse working on a Tele floor. I understand what the different cardiac meds (beta blockers, Ace-inhibitors, antihypertensives,ARB's etc.) do-or better, what their function is. But I have a hard time knowing when to hold a med (particularly when there are no parameters) when the blood pressures are borderline systolics maybe 100 or in the 90's, maybe with a low diastolic as well. The heart rates can sometimes be within normal range or slighlty bradycardic (in the 50's). Unfortunately I work on a unit where questions aren't welcome very much.
You got some real good information here. As a nurse working in the cath lab I am able to ask my MDs a variety of questions as to why they use a particular medication or not. I have one doc who has me hang a NTG drip on everyone that he stents. His reasoning is that the NTG keeps the coronaries from spasming post stent placement, thus avoiding spontaneous restenosis. He will have me hang regardless of SBP. The only exception if if the SBP is in the 80s.
Also, I know its uncomfortable to call an MD in the middle of the night about a medication order. Before making the call, take a look at the patient's trends. (i.e.; How long has the patient been on this med at this dose, what is the average BP and heart rate, does the patient exhibit any signs or symptoms associated with low BP and heart rate.) If the patient has been on the same medications at the same doses and the trend is a continuous drop in BP, the MD may be interested, if its a new med and the BP dropped more than 20 mmHg, he will DEFINITELY be interested in that trend. If the BP has remained fairly consistent on the same med, give the med and don't make the call. Knowing the trend before making the midnight phone call will signal to your MD that you did your research before resorting to the phone call.
Remember, MDs are on call 24-7. If they are not the one on call for the night, there will be another MD covering their call. This is why they make the "big" bucks. It is not our jobs as nurses to make medical decisions for them. By knowing current vitals and the trends of the patient before making the phone call, you have all the information at your fingertips that you need to make your phone call. The on call MD will appreciate the fact that you don't have to search around for information while on the phone with him/her and a decision can be made quickly.
nurse.darcy
5 Posts
Hello,
You got some real good information here. As a nurse working in the cath lab I am able to ask my MDs a variety of questions as to why they use a particular medication or not. I have one doc who has me hang a NTG drip on everyone that he stents. His reasoning is that the NTG keeps the coronaries from spasming post stent placement, thus avoiding spontaneous restenosis. He will have me hang regardless of SBP. The only exception if if the SBP is in the 80s.
Also, I know its uncomfortable to call an MD in the middle of the night about a medication order. Before making the call, take a look at the patient's trends. (i.e.; How long has the patient been on this med at this dose, what is the average BP and heart rate, does the patient exhibit any signs or symptoms associated with low BP and heart rate.) If the patient has been on the same medications at the same doses and the trend is a continuous drop in BP, the MD may be interested, if its a new med and the BP dropped more than 20 mmHg, he will DEFINITELY be interested in that trend. If the BP has remained fairly consistent on the same med, give the med and don't make the call. Knowing the trend before making the midnight phone call will signal to your MD that you did your research before resorting to the phone call.
Remember, MDs are on call 24-7. If they are not the one on call for the night, there will be another MD covering their call. This is why they make the "big" bucks. It is not our jobs as nurses to make medical decisions for them. By knowing current vitals and the trends of the patient before making the phone call, you have all the information at your fingertips that you need to make your phone call. The on call MD will appreciate the fact that you don't have to search around for information while on the phone with him/her and a decision can be made quickly.