Why did I give the med before surgery?

[coffeeandpiano]

I've been a med-surg nurse for over 5 years. I gave a patient with history of CHF bumex prior to surgery, as order said NPO except sips with meds. Post surgery he became tachycardic and hypotensive and a neo drip was started. He is going to the ICU rather than the med surgery room he came from. I was driving home and realized, "Oh crap I gave him the bumex this morning. Why in the world didn't I hold it?" One of those regrets that might have not cost him the extra medicines/boluses of fluids if I had held it. :( I wish guidelines were given for which medicines to hold and not hold better for med surg nurses. Not all of us have an ICU or PACU history. Anyway, that is my regret of the day. :(

-Disappointed in herself nurse hoping the patient will recover ok

[canoehead, BSN, RN]

It was ordered, and its reasonable to assume that the doc indicates he has looked at the meds being appropriate for surgery if he wrote that order. I would have given it.

[Rose_Queen, BSN, MSN, RN]

First, take a deep breath. Second, realize that yes, surgeons should be reviewing medication orders and indicating which ones should be held. It is not at all a common practice to hold all medications prior to surgery, and the ones that are routinely held tend to be the anticoagulants (and even some of those aren't held or are switched to a different medication!). I've had nurses think, oh, the patient is NPO for surgery- I should hold their insulin. Guess what? Part of the stress (and surgery is indeed stressful) response is an increase in release in stress hormones, which in turn increases blood glucose levels- and the anesthesia staff would much rather have a lower blood sugar reading than a higher one as higher levels are associated with increased risk for complications.

There is so much more that goes into causing tachycardia and hypotension in the surgical patient beyond whether or not they had a diuretic that day. Anesthesia agents themselves have the capability to cause hypotension. A patient with CHF is going to be known to have risks of complications not only from surgery but also from anesthesia.

Additionally, the decision to hold a med without orders is practicing medicine and beyond the scope of your practice. If you had chosen to hold the med, you should have notified the provider and he or she could have said you needed to give it anyway.

[Just me.]

Unfortunately, we have all probably been there. I would fill out an RL solution so the situation can be reviewed. Speak to your manager and ask her to inquire of the OR if this is a med that should have been held. In my opinion, the should have put a stop order on the med...if they didn't want it to be given. Did they even intend for it to be held? Ideally, you would have clarified whether or not to give it. But it doesn't sound like you were told not to give it.

[Rose_Queen, BSN, MSN, RN]

2 hours ago, Downhearted said:

Speak to your manager and ask her to inquire of the OR if this is a med that should have been held.

The OR cannot make this determination- it’s outside of their scope. The only one who can answer that question is the surgeon as there is no hard and fast rule that every med must be stopped on every patient prior to surgery.

[Just me.]

Thank you for clarifying my ill communicated thought, assumption of pre-op med list.