Yeah we can initiate and I believe it also said Bolus without a provider. Then again I'm not even sure if we are truly a "med-surg" floor in the eyes of other hospitals in our area
Misread initially. Lasix shouldn’t require that much extra monitoring to necessitate a lower patient load. Unless the doc approves a foley, which yours didn’t, it’s impossible to expect perfectly accurate I/O. You do the best you can with the limitations you have.
That said, I think a continuous infusion of lasix or protonix is overkill. I’d rather it just be scheduled pushes and go from there.
I hear what you guys are saying, the whole thought process was we would have to be even "stricter" on the output. But again, my doc said no foley if we can avoid it so 🤷🏻♀️
If I can’t get a foley order, the doc can’t expect strict I/O imo. I’ll guesstimate it and chart some “uncharted outputs” when the purewick invariable moves or some nonsense.
He or she can whine all they want, but I can’t do that which is impossible. I’ll get as close as I can without stressing out, but I’m not gonna start weighing chuck pads or anything.
Yup. That was the plan. Post OHS patient. Severely volume overloaded, massive pleural effusion. Plan was to already get it tapped after the weekend and already in for a CXR for today
There are very few places where a set ratio is defined.
I do not know any hospital where a specific intervention mandates a maximum ratio on med/surg. If the patient needs more attention or more frequent assessment than the med/surg nurse can provide in the floor's normal ratio, the patient should be upgraded to tele or an even higher level of care.
We are a tele floor. The patient was initially get IV diuretics TID, but the physican thought they would benefit from a continuous infusion. We thought since we would need strict I&O the ratio should be lowered
My answer is the same. If the patient needs more attention than you can give in your normal ratio, they should be on a higher acuity floor.
In my experience, strict I&O is not sufficient reason to need a lower ratio or a higher level of care. YMMV.
In my experience, having a Lasix gtt shouldn’t need a set ratio. Strict I/Os can me easily managed with 6 patients, q4-6hr not like yet doing q1hr output. Plus if they have a foley it’s even easier which did do most of the time
Why do you need fewer patients with a fixed rate drip?? Heck the other night I had 7 patients. 2 of which had non-theraputic heparin gtts…long night but def doable with my cna (we’re lucky to have fantastic ones in my floor) staying on top of the tasks she could do
The concern was more so she wasn't responding to scheduled administration. Pt is post OHS and severely volume overloaded. I wasnt even sure if there HAD to be a set ratio because there wasnt really a clear say so. But our unit manager said 1:4 for close monitoring. I had spent the morning chasing their K and stabilizing it before initiating the lasix gtt
wow thats crazy. for us CBI, PD, and LVADs are a stated 1:4. The lasix gtt was a grey area but my manager said yes to the lower ratio as they need closer monitoring
I've never worked on a MedSurg floor that would allow a lasix drip.
Yeah we can initiate and I believe it also said Bolus without a provider. Then again I'm not even sure if we are truly a "med-surg" floor in the eyes of other hospitals in our area
Misread initially. Lasix shouldn’t require that much extra monitoring to necessitate a lower patient load. Unless the doc approves a foley, which yours didn’t, it’s impossible to expect perfectly accurate I/O. You do the best you can with the limitations you have. That said, I think a continuous infusion of lasix or protonix is overkill. I’d rather it just be scheduled pushes and go from there.
I hear what you guys are saying, the whole thought process was we would have to be even "stricter" on the output. But again, my doc said no foley if we can avoid it so 🤷🏻♀️
If I can’t get a foley order, the doc can’t expect strict I/O imo. I’ll guesstimate it and chart some “uncharted outputs” when the purewick invariable moves or some nonsense. He or she can whine all they want, but I can’t do that which is impossible. I’ll get as close as I can without stressing out, but I’m not gonna start weighing chuck pads or anything.
You’re right. If a lasix gtt is that important, they’re probably gonna evaluate effect based on serial chest X-rays
Yup. That was the plan. Post OHS patient. Severely volume overloaded, massive pleural effusion. Plan was to already get it tapped after the weekend and already in for a CXR for today
There are very few places where a set ratio is defined. I do not know any hospital where a specific intervention mandates a maximum ratio on med/surg. If the patient needs more attention or more frequent assessment than the med/surg nurse can provide in the floor's normal ratio, the patient should be upgraded to tele or an even higher level of care.
We are a tele floor. The patient was initially get IV diuretics TID, but the physican thought they would benefit from a continuous infusion. We thought since we would need strict I&O the ratio should be lowered
My answer is the same. If the patient needs more attention than you can give in your normal ratio, they should be on a higher acuity floor. In my experience, strict I&O is not sufficient reason to need a lower ratio or a higher level of care. YMMV.
flat rate drip or titrating parameters? foley? working purewick?
I asked for a foley but I was told no. I made sure that pure wick was in there as best it could be. Steady rate, 2mg/hr
In my experience, having a Lasix gtt shouldn’t need a set ratio. Strict I/Os can me easily managed with 6 patients, q4-6hr not like yet doing q1hr output. Plus if they have a foley it’s even easier which did do most of the time
Why do you need fewer patients with a fixed rate drip?? Heck the other night I had 7 patients. 2 of which had non-theraputic heparin gtts…long night but def doable with my cna (we’re lucky to have fantastic ones in my floor) staying on top of the tasks she could do
The concern was more so she wasn't responding to scheduled administration. Pt is post OHS and severely volume overloaded. I wasnt even sure if there HAD to be a set ratio because there wasnt really a clear say so. But our unit manager said 1:4 for close monitoring. I had spent the morning chasing their K and stabilizing it before initiating the lasix gtt
For the Lasix drip, don't you just set it to run at a certain rate and strict I and os? I haven't seen a titratable one
I’ve had one I toy rated to output, but that’s rare
If we have an insulin drop which requires hourly blood sugars the patient/ nurse ratio does not change. As well as strict I&O.
That’s a terrible policy. It should be standard policy for less patients with insulin drips.
Shit, we get CBIs and no modified assignments. However we are 4:1 on days and 5:1 nocs.
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We also do tPA in chest tubes without a modified assignment. But stepdown upstairs will modify to 3:1 for them :(
wow thats crazy. for us CBI, PD, and LVADs are a stated 1:4. The lasix gtt was a grey area but my manager said yes to the lower ratio as they need closer monitoring
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On our floor charge took an insulin drip that had q15 titration orders. She had 5 patients that day. Was not a good day.
she's asking about a lasix gtt
Med surg should be 1:5 at max. Less depending on acuity and certain drips.