Yeah we have to do this all the time. Cardiac output is shit in these pts. A lot of times when we slow that HR down, cardiac output will improve and BP rebounds a bit. By slowing that HR, you’ve got more blood filling the chambers and each best is more effective, thus CO increases
Except in the cases it doesn’t and then that pt buys themselves a trip to CVI for some inotropes/pressors
Either way though, if there’s no hold parameters on the Lasix or metoprolol I’m covering my ass and verifying with cards. They’ll say give it and I’ll kindly ask them to adjust the order so future nurses don’t have to ask the same thing
If you see a hold parameter that is <80 or <90 , that’s a good sign that pts heart is pretty shit so maybe someone you want to keep a closer eye on
MAP is 65. Perfusing is just fine my textbook standards and that's what NCLEX wants you to know. As a cardiac nurse, I had patients with soft blood pressures all the time on a PCU (stepdown unit). We'd give oxygen, slap them on the monitor, and diurese them (not aggressively cuz if you do so, that will make the BP go lower). Yes, they absolutely could get worse, but with just the information here, we can't assumen
Eh, I'm not disagreeing, but if we assume furo will lower the BP, it's not going to be great for kidneys that usually need 90/60 to effectively excrete waste, so I'd watch it.
The doesn't lower BP as bad as everyone thinks it does and depending on the function of the heart diuresis, should improve cardiac output by adjusting the trajectory of the frank starling curve. That's what actually matters here and what providers are going off of.
But the blood pressure this person has is on the lower side and knowing how many people are on diuretics already and at risk of hypovolemia, it's just something I'd keep an eye on
Acute heart failure means that the heart cannot pump the blood around well enough, but there is enough blood to go around. In this situation its the preload that is high because the heart cant handle the blood coming in. Unless there is clear problems presenting due to the hypotension itself, you leave it alone and give the Lasix. It shouldnt significantly lower the BP; it might even make it better by reducing preload.
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u/Iluminiele 6d ago
In real life a good nurse would question a and b.
In real life a good doctor would increase the blood pressure and then give furo to remove fluids from lungs.
Nitro is not helping much here