Why would these IV meds be on my tomorrow patient's chart?

medic9872 · Sep 24, 2012

Is the pt able to eat or are they npo still? Did they experience a lot of blood loss during surgery? Those are potential reasons for the iv fluids.

The pt could have a history of gerd as well as the depression. That could be the reason for the protonix. Also, sometimes the meds don't drop off after surgery is over and the pt is able to eat and drink again. The LR and NS may be left on the chart for that reason. It sounds like the pt is able to swallow pills so I would ask about it. Protonix is also typically given pre-op as well.

Have fun at clinicals! Sounds like you're on the right track with your prep work.

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Samian Q · Sep 24, 2012

His/her surgery was on Friday, so I'm quire sure that they're off of NPO by now!! (I'll definitely check the chart in the morning, just to be safe, obviously). And I'll ask about the IV fluids, then. It's been befuddling me for a while now.

TLH1999 · Sep 24, 2012

Patients are often placed on protonix or a med in its class to help prevent GERD issues due to the stress and medications they may get. Therefore, if pt has no history of GERD it is a prophylactic drug. Depending on when the patient had surgery and how they are doing hemodynamically will determine the reason for the IV fluids.

Aurora77 · Sep 24, 2012

To throw a wrench into the works--are they still actually on IV fluids? Our standard orders are to hep lock the IV on the morning after an ortho surgery. Our ortho docs don't necessarily officially discontinue the order for fluids, even though it's understood they are d/c'd when the IV is locked. The order may still be the chart, but be superceded by our protocols. Our ortho patients are almost always on LR at 125 while they're in PACU, then LR, NS, or D5LR on the floor, at 63 or 75 depending on the doc. if they are still on fluids, what is the reason for having them on LR or NS? What do those fluids do in the body?

You're also on the right track with the oxy, but you aren't there yet. If the oxy is not PRN, then it's a scheduled med, most likely sustained release. Will an SR med start working in 15 minutes?

Good luck tomorrow! I mostly work ortho and love it.

Samian Q · Sep 24, 2012

To throw a wrench into the works--are they still actually on IV fluids? Our standard orders are to hep lock the IV on the morning after an ortho surgery. Our ortho docs don't necessarily officially discontinue the order for fluids, even though it's understood they are d/c'd when the IV is locked. The order may still be the chart, but be superceded by our protocols. Our ortho patients are almost always on LR at 125 while they're in PACU, then LR, NS, or D5LR on the floor, at 63 or 75 depending on the doc. if they are still on fluids, what is the reason for having them on LR or NS? What do those fluids do in the body?
Good luck tomorrow! I mostly work ortho and love it.

You know what, you bring up a really good point. I got a quick glimpse of the patient earlier today, by coincidence, as I was looking at their binder, and I didn't notice an IV line on that patient. By the way, the patient was ambulating down the hall on a walker. I wonder what that has to do with their arthroplasty at this point and time.. hmmmm...

I found the computer system's explanation of the meds to be a bit ambiguous (to put it mildly!). The computer system listed all the meds that were currently active on the patient, and when you scrolled down, you also saw a list of d/c'd meds as well.

What I do know about LR and NS are that they are both isotonic solutions; ergo, I think these fluids compensate for blood loss post-operatively, or are given when a patient hooked on an IV system is dehydrated.

Still... not exactly sure why both of these solutions would be ordered, instead of just one of those.

Samian Q · Sep 24, 2012

Oh and thanks for the best wishes :)

Apparently tomorrow I'm going to have to take vital signs, do a dressing change, get the patient to cough and use the incentive spirometer hourly, do a focused assessment, figure out the monstrous maze that is computer charting, do hygiene and linen changes, DOCUMENT linen changes and hygiene (WHY?!), give meds, figure out where each of the hospital supplies are on the med-surg unit, and 50,000 other things I hope I'm not forgetting.... all on Day 1.

I am scared out of my willies :/

akulahawkRN, ADN, RN, EMT-P · Sep 24, 2012

You know what, you bring up a really good point. I got a quick glimpse of the patient earlier today, by coincidence, as I was looking at their binder, and I didn't notice an IV line on that patient. By the way, the patient was ambulating down the hall on a walker. I wonder what that has to do with their arthroplasty at this point and time.. hmmmm...
I found the computer system's explanation of the meds to be a bit ambiguous (to put it mildly!). The computer system listed all the meds that were currently active on the patient, and when you scrolled down, you also saw a list of d/c'd meds as well.
What I do know about LR and NS are that they are both isotonic solutions; ergo, I think these fluids compensate for blood loss post-operatively, or are given when a patient hooked on an IV system is dehydrated.
Still... not exactly sure why both of these solutions would be ordered, instead of just one of those.

Something to look at is why is the patient on Lovenox? What does Lovenox do? I know you already answered some of that above, so what would ambulation of the patient do? What tends to happen to patients that are in bed and immobile for a long period of time?

Something else to consider about IV solutions is that some medications are compatible with certain IV solutions and not compatible with other IV solutions. It might be worth checking your patient's medication list see if there are any IV medications that might have to go in one solution or the other because of incompatibility issues.

I'm not going to give too much away about LR and NS… But you are on the right track and that they are both isotonic crystalloid solutions. Compared to blood, what do they lack? What happens to blood in those solutions? Being that your patient recently had a surgery, might that patient require blood?

Don't worry if some of the questions that we pose to you in a little bit advanced for where you are at. You really probably already know most of the answers intuitively. Think about what was done to the patient or why did patient is in the hospital and then think about what might need to be done to correct the problem.

As you learn the medications, you will learn that certain medications are commonly given for certain reasons, much like Protonix or Colace, for instance. In certain kinds of patients, you will see them a lot.

And congratulations on finding your 1st patient as a nursing student! When it comes to choosing patients, don't just go for the ones that have a minimal medical history or a short medication list, rather go for the patients that you can learn something from. I, for instance, just recently chose a patient that has a rather extensive medical history, but a very short medication list. It chose that particular patient precisely because I wanted to work on different specific aspects of patient care. This patient needed some TLC. He got close continual assessment, some medications as needed/ordered, and a lot of TLC that was needed. That was something that I want to work on. Choose the patients that will give you some kind of a challenge, some kind of learning opportunity, even if it is something as "soft" as giving TLC.

sapphire18 · Sep 24, 2012

You'll be fine:)

As for both LR and NS being on the MAR, sometimes the NS flushes are on there since they are a "medication." Is that what you were seeing, or was it at a rate?

In terms of documenting hygiene/linen changes, if it wasn't documented, it wasn't done!

Good luck tomorrow!

Samian Q · Sep 24, 2012

Lol, actually, my nursing preceptor assigned each of us the patient's room number, so I didn't have much of a choice in the matter

Wait!! Is the patient walking because ambulation decreases the risk of DVTs and/or PE? That would make sense, if that's what it is.

But how often is the nurse supposed to get the patient ambulating on the walker? I was already a bit overwhelmed by the computer system as it is, so I definitely couldn't find "Walk the patient q4h" (for instance) on the nursing interventions section.

Well, for starters, the RBCs have blood components. LS and NR may be isotonic with blood, so they won't necessarily cause fluid shifts within the body or fluid/electrolyte imbalances, but they do lack things like hemoglobin.

(Am I getting lost? Am I way off?)

I did look up the patho for a hip arthroscopy and I sort of wonder what kind of complications could result from ambulation.

As for the protonix, I think TLH1999's reply made sense to me. If the patient were on that drug, then he or she would have less of a risk for GERD. How does epidural anesthesia affect the GI system, though? Don't epidurals for hip arthroplasties just affect the lower half of one's body?

rnmalex · Sep 24, 2012

Ambulation after arthroplasty is important and well-timed. Lovenox is often given to most of the patients I've seen in the hospital just because they are often in bed a lot, and therefore at risk for blood clotting. Lovenox will hopefully prevent the clotting from occurring - if a clot occurred and the patient began to ambulate, what would happen then?

Samian Q · Sep 24, 2012

Aha!! Then the clot would dislodge and quickly go to the area of lowest pressure (i.e., the lungs), and then it would become a pulmonary embolism and you'd have a major crisis on your hands! I think they give fibrinolytics ('clot busters') to patients who actually have a clot, instead of those who are at a risk for a clot, in those cases.

Am I right?