When things at work make you think of allnurses.com

I think we've all have that "aha-I read that on allnurses" moment

A few weeks ago I was reading a thread on here about pushing a med when a patient already has something infusing into a line and the two aren't compatable. A few people mentioned that, depending what's already infusing into the current IV, you might need to start a new line. I had not really thought about that fact since I haven't been in that situation. Normally I would just stop the infusion, flush the line, push the med, and flush and restart the infusion.

Fastforward to a few nights ago....

I had a patient on a Bumex drip. Their pressure and hr was dropping (bp 80s/50s, hr in the 40s), so the MD wanted to start a Dopamine drip. Ergo, I had to start a second line. Now the patient had 2 med infusing, neither of which I could stop. And then the patient was having severe pain, so the MD ordered Morphine. So there I am, with a patient with 2 IV infusions that can't be stopped and a med I need to push. My first thought was... "This is what they were talking about on allnurses!"

So I put a 3rd peripheral line in.

I'm more interested in what's happening with the hypotensive/bradycardic pt. on a bumex drip whose physician thinks throwing morphine and dopa on board is a good idea.

Mike A. Fungin RN said:

I'm more interested in what's happening with the hypotensive/bradycardic pt. on a bumex drip whose physician thinks throwing morphine and dopa on board is a good idea.

Long story short, the patient was in acute renal failure which was unexpected. No history of it. pt was sent in by his PCP because he felt pt was in CHF, hence the Bumex. However, when pts original labs were drawn (mind you this was all on night shift at a small hospital with a covering APRN) pts BUN was 125 and Creatinine was 5.5. BNP was >1000, he had crappy sounding lungs, and +4 pitting edema to his lower extremities. So pt starts to become hypotensive on the Bumex but the PCP couldn't be contacted to DC it. So the house APRN opted for the Dopamine, at a renal friendly dose of course, in hopes that it would maintain pts pressures long enough to keep the guy stable so he could be transfered out in the AM for dialysis.

Originally I had given vicodin for the patients pain, but it wasn't touching it. It was decided if we could maintain pts pressures greater than 100/60, which we did, pt could have a single low dose of the morphine to keep pt comfortable until transport was available.

Trust me, we all knew we were just spitting in Niagra Falls with the whole thing but it was what it was and it actually worked out quite well. Pt got sent out for dialysis early in the AM, as soon as everything was set.

allnurses has become the part of my life since I started my pre-reques for nursing. I don't rememeber how I found it, but think I'm blessed it's with me.

inkedRN said:

Trust me, we all knew we were just spitting in Niagra Falls with the whole thing but it was what it was and it actually worked out quite well. Pt got sent out for dialysis early in the AM, as soon as everything was set.

I was just curious what was being done about preload, since it sounds like he was on the dry side intravascularly. Morphine can make that worse, and the dopa doesn't really fix it (it'll get you a good BP, sure, right up until he goes into PEA).

I might be nitpicking, it just struck me as odd interventions with the information given.

Great thread and discussion. Glad to hear the pt ended up OK :)

It's threads like this where by nurses sharing experiences, discussing cases like this with critical thinking that I love reading! It's such a great way to have a shared learning experience.

Would love to hear other stories where things you all read on AN happened in real life on the job

FYI, I stuck the thread to get more attention to it :)

I have gotten exam questions right because of things I have read here on AN.

Particularly as an RN who is currently more administrative than providing actual nursing care, I so appreciate this forum. I've re-learned more in the last few weeks of perusing here than I have in years.

roser13,

Thanks so much for the feedback, we hear that all the time and it's news to out ears! The benefit of passive knowledge from others is great!

I need some advice. HELP! I work in a small rural hospital. We have pt's from 2 months to 100 yrs old, all on the same floor. I'm not a pediatric nurse, never wanted to be, don't want to be. But sometimes It works out that I am. I had an infant with resp. probs. One med ordered seemed out of line. I looked it up. It was well above the dose listed in the med book. I raised an alarm, the MD said give it, to make a long story short, the pharmacist, was called, the ER doc was called. I didn't give it, even though the pharmacist and the attending said it was ok. Now I am not allowed to care for this particular MDs pts. I am a nervous nellie and dangerous to his pts because I am so cautious.... I'm feeling really bad about myself, because I AM extremely cautious. I need some tough advice. Don't spare the punches. What would you have done?

Need more information in order to give you an answer. The fact the other MD and the pharmacist said it was OK should mean it was OK unless this particular MD is such a jerk they are afraid of him/her. The main thing is to understand what is wrong with the patient and the reason the med is ordered and what it might do if it was too high of a dose.