Toradol - pt with potential renal failure - would you administer?

Nurses General Nursing

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I had a 70 y/o patient admitted the other night from a back surgery. As I was getting her history from her daughters and got to the renal section to ask if she had kidney failure, they said that it hadn't been diagnosed but she has been having some low urine output and she was set to see the renal doctor in a few weeks. However they also vaguely said that it had been improving over the last year. She had been having quite a bit of pain so her surgeon ordered 15mg of toradol and a norco 10 to be given q6h rather than prn.

I was drowning with 4 other post-op patients and probably should have questioned the order with the dr. but I administered the toradol, only to end up worrying about it the next day once I finally had some rest (you know how it is nurses...)

What would you have done?

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I would assume she had preop labs?

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Specializes in Nephrology, Cardiology, ER, ICU.

No, I never order toradol unless I know the pts current (within the last 24 hours) creatinine.

I take care of renal pts and have two pts who went into acute renal failure and they did not recover.

However, that said, as a nurse, yes I have given toradol when I thought I shouldn't for the same exact reasons you state. At this point, its a done deal - I wouldn'tlet it worry you.

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I've seen urologists presribe it, but then they know all the info.

Surely, you had a stop order in place after 72 hours? That's how I usually see it written, as a prn (to back up a morphine order) with the order valid for the first 72 hours post op.

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I've seen urologists presribe it, but then they know all the info.

Surely, you had a stop order in place after 72 hours? That's how I usually see it written, as a prn (to back up a morphine order) with the order valid for the first 72 hours post op.

Our standing orders for toradol post op are prn and dc'd 24 hours post op. But this surgeon just ordered toradol q6h, scheduled, and without a stop order, as the patient was to be discharged in the morning.

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Specializes in Oncology/Haemetology/HIV.

Low urine OP does not necessarily mean renal failure, especially in an older pt who may not be drinking enough. Plus there are plenty of renal failure patients that void a great deal.

I would have looked at the labs, and checked the lytes and creatinine.

Presumably, the surgeon and/or PCP did a full workup w/labs and H&P. Those issues would have been assessed.

The MDs also may have assessed the risks/benefits of using narcotics vs NSAIDs on an older pt.

The other issue is the dose level. Was it a high or low dose, and when did the order expire.

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I checked the labs before administering, but apparently they didn't order a metabolic panel because I could only view the post-op hematology.

This is off topic, but there are so many things about nursing that make me feel paranoid - am i going to be sued for this or that, did I forget to do this before my shift ended, what should I have done differently? Before nursing I didn't consider myself an OCD person, but I am definitely starting to show OCD characteristics. Should I just let this one go and forget a/b it?

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Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
I checked the labs before administering, but apparently they didn't order a metabolic panel because I could only view the post-op hematology.

This is off topic, but there are so many things about nursing that make me feel paranoid - am i going to be sued for this or that, did I forget to do this before my shift ended, what should I have done differently? Before nursing I didn't consider myself an OCD person, but I am definitely starting to show OCD characteristics. Should I just let this one go and forget a/b it?

I am pretty surprised that they didn't order a pre-op BMP. I work in PAT/SPU and there is a protocol that we follow as to what labs to order - on a patient of that age - we would have automatically ordered one.

However, without the labs being ordered and without a formal diagnosis of renal insuff/failure - I don't believe you are truly at fault here. If the family did state that yes, she has been diagnosed with renal insuff/failure or there was a recent BUN/Cr that inidicated such and you administered it anyway, that would be a problem. What it comes down to is you probably should have consulted the ordering doc, mentioned what the family stated, and see if he still wanted the Toradol given. At this point (even though easier said than done), you need to try and let it go - it's over and done with and there is nothing that can change it. However, you will be more diligent next time and I'm sure you will make that call to the doc.

I was and am still like you! I have done that many times - second guessed myself after getting a good night's (day's) sleep and realized, "Damn, I should have done this or that." It actually does show that you truly care about your patients and that you are trying your best to be a great nurse. Try to let this go or it will eat away at you. Hang in there - you are a great nurse!

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Specializes in Maternal - Child Health.

This is off topic, but there are so many things about nursing that make me feel paranoid - am i going to be sued for this or that, did I forget to do this before my shift ended, what should I have done differently? Before nursing I didn't consider myself an OCD person, but I am definitely starting to show OCD characteristics. Should I just let this one go and forget a/b it?

Forget about it? No, because it is a learning experience. Perhaps you can discuss the appropriate parameters with the physician next time you see him/her. If you broach it as a learning experience for your benefit, most are more than willing to answer questions.

Let it go? Yes. There's nothing you can do at this point.

If you don't already know the Serenity Prayer, learn it :)

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Nursing is a learning experience...you "rehash" things. remember for the future....

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Specializes in Critical Care.

Reflection is good...it will make you a better nurse. Obsession to the point you're describing is bad, it will not help and may hinder you in the future. Would I have checked a creat? Yes, but I'm in a different role than you. What can you do about it in the future? Maybe try to find the time to check the labs (if they are ordered) or ask someone else to follow up on it before you give it.

You mentioned Toradol is a standard prn drug....you know, you could go to your manager and pilot a program where drugs such as Toradol are flagged before docs can prescribe. In our facility, pharmacy checks things like labs before allowing this to be dispensed...maybe your facility could look into something similiar? It's really another check and to be honest, many of the nurses I work with don't think to check creats. or platelets before administering. Take it to your nurse manager, offer your opinion..it may lead to something good.

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You gave 15mg Toradall-a standard dose for a person of your patient's age. I would assume her medical doctor cleared her for surgery, as it does not appear to have been a trauma case. Her surgeon and her medical doctor are probably both aware of any problems with her kidney function and would not have ordered it if they felt it put her in danger of acute renal failure. At some point you'll become inured to the constant threats on your license and will just do what you feel is best with the knowledge you have. We could all torture ourselves daily, but it is inevitable that there will be errors. Focus on doing your best and try to let it go when you leave work.

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