😘Hello, there are very few things nurses are legally allowed to do without a physician’s standing order, and administering IV Fluids or medication is not one of them, an order is needed. Giving too much fluid to an individual with Congestive Heart Failure, Renal Failure, or who already has a low Sodium (Na) or Potassium (K) can lead to undesired outcomes. Now…I Will Not Lie, there are times a patient’s blood pressure is dropping rapidly, and an IV Fluid Bolus may be initiated before an order is received. This is to support the blood pressure, therefore, allow some support and continued perfusion to the brain; ultimately, to sustain quality of life until appropriate orders can be received.
Depending on the setting, a Rapid Response may be called in which the order to administer fluids to support a systolic blood pressure less than 90 is a standing order, for members of your Rapid Response Team. It is important a patients receives what is needed, such as Blood Products (Platelets, Plasma, or Whole Blood) or vasopressor such as Levophed, Dopamine, or Vasopressin not just fluid replacement. For example, if someone feels weak and an in experienced nurse decides, “it’s probably just dehydration” and administers a bolus, but the patient has an electrolyte imbalance such as Hypokalemia (low potassium) or Hyponatremia - the patient could have a heart attack.
This is why when it comes to patient care it is important to follow your Scope of Practice and Physician’s order, as all “Nurses are not created equally”; therefore, the “Rules of Engagement” have be standardized, and are based on evidence-based practice to avoid errors and patient harm ultimately. Now, her is the kicker there are times when a physician is in experienced (or aren’t wearing their “Thinking Cap”), and orders fluids or medication that are not safe for a specific patient, and the nurse must refuse to administer. “Nurses Are The Last Line of Safety between the Physician and The Pharmacist…Know Your Scope and Play Your Role,” (Nurse Chuckles, 2015).
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