When to dilute IV meds?

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Ayemee

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Hey everyone! When is it necessary to dilute IV meds? A girl I work with mentioned that if I inject through the extension, I don’t need to dilute. However, if I inject straight into the catheter, then I DO need to dilute. Is this correct or no? Sometimes the vet will say to dilute, which then of course, I will.

Everyone has their own strong opinions at the place I work so I won’t to make sure I don’t screw up.

Thanks!

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It depends on which drug and what the concentration of such drug is..
 
Well, that doesn’t make things any easier. Haha. I will just have to ask until I can remember them all. Does it hurt to dilute if I’m ever unsure?
 
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Once you get used to them you'll know. Can't go wrong with just diluting them all until you know. I mean protonix or something I don't dilute beyond the ordered dilution amount, but morphine there are obvious reasons why. Antibiotics, obvious reasons why its a good idea.
 
Once you get used to them you'll know. Can't go wrong with just diluting them all until you know. I mean protonix or something I don't dilute beyond the ordered dilution amount, but morphine there are obvious reasons why. Antibiotics, obvious reasons why its a good idea.
Sounds great :) When diluting, is it typically the same amount of drug ordered of sterile water? We have cheat sheets, but it seems that only the dilution for unasyn (ampicillin sulbactum) is displayed so I didn’t know if it’s a typical routine.
 
Some things you dilute in saline, some you use sterile water. Depends on the osmolarity of the drug.
 
Hey everyone! When is it necessary to dilute IV meds? A girl I work with mentioned that if I inject through the extension, I don’t need to dilute. However, if I inject straight into the catheter, then I DO need to dilute. Is this correct or no? Sometimes the vet will say to dilute, which then of course, I will.

Everyone has their own strong opinions at the place I work so I won’t to make sure I don’t screw up.

Thanks!

Unlike the poster who has been responding, you should do absolutely NOTHING that poster is suggesting.

If you are uncertain about whether to dilute something or not when giving the injection then you need to ask the vet in charge of the case. You do NOT assume that is should or should not be diluted. You do NOT assume that placing it in the line is enough dilution. Etc, etc, etc. It isn't your license on the line when treating these patients, it is the vets. That means if YOU make an error because you didn't clarify with the vet what they wanted, then the VET is who gets in trouble when **** hits the fan and the patient has an adverse reaction or event. When you aren't sure about something, you ask the vet. Period. End of.

If I knew one of my techs/assistants were on some internet forum asking a bunch of random strangers this question instead of clarifying any questions/concerns with me, I would have them fired so fast, their head would spin.

The only appropriate answer to your question is to ask the vet in charge and the above poster giving suggestions including "dilute until you learn otherwise" should be downright ashamed of him/herself for even making such a suggestion.
 
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Like I said it depends on the drug. But how often is an attending going to say "oh yeah. Mix that 2 mg morphine in 5 ml saline before you give it"? And if you mix it in 5 or 10 does it really matter? The risk is slamming it too fast sending the patient into respiratory depression.

Some drugs such as adenosine or lidocaine you're obviously not going to dilute because it's not going to have the intended effect. I'm not speaking about all medications. Im speaking on IVP antibiotics, pain medications, etc. you obviously need to know what medication you're giving. Like I said the osmality of the drug affects whether you're going to dilute in saline or sterile water.

I didn't mean that ANY drug can be prepared diluted. I should have worded that better, my apology.
 
But yes, listen to the vet. I'm speaking based on having a pharmacology understanding. If I had no idea what a drug was, I would not only ask what they want done, but look it up in a drug manual myself.

When I'm giving a drug I know it there is a danger of it being given diluted and undiluted, and when I usually give advice to newer RNs it's usually "make sure you dilute that morphine in at least 5ml of water and push it over a few minutes so you don't have to narcan them" etc.

If you aren't practicing under your own license most definitely ask first.
 
Like I said it depends on the drug. But how often is an attending going to say "oh yeah. Mix that 2 mg morphine in 5 ml saline before you give it"? And if you mix it in 5 or 10 does it really matter? The risk is slamming it too fast sending the patient into respiratory depression.

Some drugs such as adenosine or lidocaine you're obviously not going to dilute because it's not going to have the intended effect. I'm not speaking about all medications. Im speaking on IVP antibiotics, pain medications, etc. you obviously need to know what medication you're giving. Like I said the osmality of the drug affects whether you're going to dilute in saline or sterile water.

I didn't mean that ANY drug can be prepared diluted. I should have worded that better, my apology.

This isn't human medicine it is veterinary medicine. We don't regularly give morphine. We occasionally give lidocaine but not in the way you're discussing. Never seen adenosine in a vet clinic, ever.

Pharmacology in animals is different than in humans. Vastly different. Dogs and cats aren't mini people.

The only answer to the question is to clarify what the vet wants and how they want it administered if you are uncertain.

You can't compare what you do as a human nurse to what a vet tech does, they are extremely different. Please stick with nursing and not advising on treating veterinary patients.
 
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Like I said it depends on the drug. But how often is an attending going to say "oh yeah. Mix that 2 mg morphine in 5 ml saline before you give it"?
Maybe it's different in human med (which if that is in fact the case, I'm frightened for human patients), but I've never not been given explicit instructions on administering a drug.

Someone who is not prescribing the drug should not be the one determining how it is given, if it should be further diluted or not, etc.
 
Maybe it's different in human med (which if that is in fact the case, I'm frightened for human patients), but I've never not been given explicit instructions on administering a drug.

Someone who is not prescribing the drug should not be the one determining how it is given, if it should be further diluted or not, etc.

From what I know about human medicine (especially in hospital settings), it is fairly common for a Dr to just give the order of "Give Y mg of x drug" without any further instruction and the nurse/nurses know how to administer it. But that is why this person needs to stop commenting because nursing is SO different than that of a vet tech or assistant.

Vets do regularly explain to give x drug and dilute with x amount saline or sterile water. Or give x drug as x%. Or don't place that drug in the IV line as the Ca/Mg will have an effect and you will crystallize your line, give via direct catheter port and stop fluids while administering. Or give that medication over x minutes. A lot of really good licensed techs will have some of this memorized and many of them can figure out dosages without added help, but in our field it is much more appropriate to ask the vet if you do not know. In human med, it is more likely a new nurse would ask a more experienced nurse rather than the MD themselves.

Vets do give much more direction than human doctors simply because of the nature of our jobs and the training our assistants/techs may or may not have. We tend to know a bit more of the technical aspect of things than human doctors do as well.
 
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From what I know about human medicine (especially in hospital settings), it is fairly common for a Dr to just give the order of "Give Y mg of x drug" without any further instruction and the nurse/nurses know how to administer it. But that is why this person needs to stop commenting because nursing is SO different than that of a vet tech or assistant.

Vets do regularly explain to give x drug and dilute with x amount saline or sterile water. Or give x drug as x%. Or don't place that drug in the IV line as the Ca/Mg will have an effect and you will crystallize your line, give via direct catheter port and stop fluids while administering. Or give that medication over x minutes. A lot of really good licensed techs will have some of this memorized and many of them can figure out dosages without added help, but in our field it is much more appropriate to ask the vet if you do not know. In human med, it is more likely a new nurse would ask a more experienced nurse rather than the MD themselves.

Vets do give much more direction than human doctors simply because of the nature of our jobs and the training our assistants/techs may or may not have. We tend to know a bit more of the technical aspect of things than human doctors do as well.
Yep, still frightened for human patients. I'm kidding, a little.

I've seen some nurses put their own spin on how they think things should be done, even with my own personal care, so I find it a little concerning that there could be so many inconsistencies going on there. I'm aware that happens in vet med too, but I feel it's a little less frequent (or the techs are less in your face about it). I constantly see/hear nurses putting down doctors and talking about how they make their own decisions on the hospital floor because they feel the doctor is an idiot. I rarely see/hear it coming from vet techs, relative to the frequency of RNs. The FB presence of salty RNs is astronomically high nowadays too :p
 
Puppy why are you concerned? There is no difference if you mix Merrem with 10 ml of water or 20 ml really. Or 2 mg morphine IVP in 5 or 10 ml. It simply facilitates slower pushing, so I like to opt for more diluent.

As far as crystallization, my patients usually have PICCs or central lines so I try to use them consistently to prevent outcomes such as those.

I think older RNs become jaded just as any profession will. old MDs are very jaded as well, and I was jaded in my military career. Its one reason I enjoy learning a new field- you see it with fresh eyes. Those vet techs have been doing it for how long? Many of these CCRNs have been in critical care for 15+ years.

DVM I appreciate the advise, and apologize for any confusion. This was a good learning moment, and I appreciate every one of those I can get.


I'll admit I don't understand vet care. I lost my German Shepherd to infection sp MVA due to infection a few years back. I brought her to the vet as soon as I heard the news and got back in less than a day after the incident when the infection was still low in her bloodstream. They had to perform a BKA on her RLE and it was successful, but she coded post surg and they were unable to revive her. I still don't understand how this happened. If she wasn't stable enough I don't understand why they would operate. Must be very different indeed..
 
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Maybe it's different in human med (which if that is in fact the case, I'm frightened for human patients), but I've never not been given explicit instructions on administering a drug.

Someone who is not prescribing the drug should not be the one determining how it is given, if it should be further diluted or not, etc.
You should just know, usually. Unless its some obscure drug that you're not accustomed to giving. For instance I make sure to tell my orientees to have someone watch the patients heart rhythm when pushing Cardizem or metoprolol incase they poorly convert.

This is very interesting that many of these drugs are not given to animals. I've always known that some drugs should never be given to animals, but I always figured heart drugs etc. would be the same just in different concentrations. I find these types of nuances very fascinating.
 
You should just know, usually. Unless its some obscure drug that you're not accustomed to giving. For instance I make sure to tell my orientees to have someone watch the patients heart rhythm when pushing Cardizem or metoprolol incase they poorly convert.

This is very interesting that many of these drugs are not given to animals. I've always known that some drugs should never be given to animals, but I always figured heart drugs etc. would be the same just in different concentrations. I find these types of nuances very fascinating.

It isn't to say we don't use cardiac drugs, we do, but only for certain conditions. We don't typically have a ton of dogs with arrhythmias chilling around in your average GP vet clinic. That's more specialty clinic and even then those animals are very critical and most owners won't have $5-10k for the multiple days of hospitalization that those cases require.

Lidocaine tends to only get broken out when a patient is throwing PVC's. Which only happens under certain circumstances such as during certain surgeries.

Panolol (I don't think I've seen metropolol in vet med but we have similar meds) only gets busted out for certain arrhythmias.

I've had a few AV blocks during anesthesia that I've had to give atropine to, but that's fairly rare too.

In vet med, you really don't have "cardiac units" of patients often.
 
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Puppy why are you concerned? There is no difference if you mix Merrem with 10 ml of water or 20 ml really. Or 2 mg morphine IVP in 5 or 10 ml. It simply facilitates slower pushing, so I like to opt for more diluent.

As far as crystallization, my patients usually have PICCs or central lines so I try to use them consistently to prevent outcomes such as those.

I think older RNs become jaded just as any profession will. old MDs are very jaded as well, and I was jaded in my military career. Its one reason I enjoy learning a new field- you see it with fresh eyes. Those vet techs have been doing it for how long? Many of these CCRNs have been in critical care for 15+ years.

DVM I appreciate the advise, and apologize for any confusion. This was a good learning moment, and I appreciate every one of those I can get.


I'll admit I don't understand vet care. I lost my German Shepherd to infection sp MVA due to infection a few years back. I brought her to the vet as soon as I heard the news and got back in less than a day after the incident when the infection was still low in her bloodstream. They had to perform a BKA on her RLE and it was successful, but she coded post surg and they were unable to revive her. I still don't understand how this happened. If she wasn't stable enough I don't understand why they would operate. Must be very different indeed..

One major difference with humans and animal patients can be size. We have some patients that are small enough that giving an extra 10ml bolus can be significant enough to fluid overload them (think of a 1kg kitten). We have species that have vastly different sensitivities to the same drugs, so you would need to dilute appropriately for one but not the other (cows vs. horses with xylazine comes to mind). PICCs or central lines aren't common, so not going to be an option - you have to be conscious of which drugs can precipitate (IV firocoxib is one), which ones have to be given slowly (KPen), etc.

What it comes down to is that veterinary medicine can be very different. Please don't assume that your knowledge of human medicine automatically correlates. Even your use of trade names and medical jargon is off (our patients don't have lower extremities, so we wouldn't refer to anything as a RLE). Also, just because your dog coded post-op does not mean that she was unstable before operating. I'm sorry that she died, but insinuating that the vets acted inappropriately based on what you think you know of veterinary medicine is insulting.
 
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I did not say that they acted inappropriately, I said that I do not understand.

Out of curiosity, in Vet speak, how would you refer to upper vs lower extremities?
 
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Also, a lot of our techs/assistants come with low level of training and formal education. The training process even for certified/registered technicians kind of assumes that th DVM will specify exactly how medications would be administered. If I want something given slowly over X minutes, or diluted 1:X with Y diluent I am very explicit in that. The only exception is if it's in an ER where certain drugs are given very commonly and there is an established protocol for those drugs and all techs are trained in it.

Literally, I was on the job trained as a 17 year old and was inducing anesthesia and intubating patients after a few months. So knowledge base is really patchy and variable. Therefore, unless a tech has a very explicit understanding with the DVM they work with that they are trusted to do anything outside of strict orders, they should never use any sort of creative license
 
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I mean is that simply abbreviated in documentation as RFL, LFL, LRL, RRL then?
Typically will specify exact region
R tarsus vs L antebrachium vs LH digit 4.

L and R for left and right is pretty typical. F and H for front and hind is pretty typical. Though I've seen R for rear
 
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Very interesting.
 
meropenem, its a carbapenem. Usually see it given for respiratory infections, but it has other indications.

Ahh. Okay. I do know what meropenem is. Heh.

I only ever say R or L front or hind limb, no further abbreviation. We have some abbreviations we use, but not a bunch. BID, TID, QID, EOD for drugs (though we always write it out for clients). HBC = hit by car, ADR = ain't doing right ( :shrug: ), BDLD = big dog, little dog... sometimes BDLDBDW = big dog, little dog (big dog won). BAR, QAR, QAL... that's about it.
 
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Ahh. Okay. I do know what meropenem is. Heh.

I only ever say R or L front or hind limb, no further abbreviation. We have some abbreviations we use, but not a bunch. BID, TID, QID, EOD for drugs (though we always write it out for clients). HBC = hit by car, ADR = ain't doing right ( :shrug: ), BDLD = big dog, little dog... sometimes BDLDBDW = big dog, little dog (big dog won). BAR, QAR, QAL... that's about it.
Or the rare BDLDLDW :p I once worked on a GSD who got his a** kicked by a chihuahua
 
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I did not say that they acted inappropriately, I said that I do not understand.
Yeah, you kinda did, by implying that they took her to surgery knowing she wasn't stable enough for surgery.


I stopped saying or writing BID, TID, SID (or UID) --- I now only write q12h, q8h, q24h etc. I don't understand why human meds are prescribed on a number of times per day basis, when number of hours between doses is really the important part. But then, I still don't understand why human meds aren't prescribed based on weight, because I just can't see how the same dose for a 105lb person and a 250 lb person could really work properly (and equally well) without causing problems.
 
Yeah, you kinda did, by implying that they took her to surgery knowing she wasn't stable enough for surgery.


I stopped saying or writing BID, TID, SID (or UID) --- I now only write q12h, q8h, q24h etc. I don't understand why human meds are prescribed on a number of times per day basis, when number of hours between doses is really the important part. But then, I still don't understand why human meds aren't prescribed based on weight, because I just can't see how the same dose for a 105lb person and a 250 lb person could really work properly (and equally well) without causing problems.
Actually, no, I don't feel that they acted inappropriately. Like I said, I didn't understand. It's not the same protocol that we follow with humans.

I agree about time between doses. But at my hospital the nurses can set the dosing schedule, so let's say a medication comes late from pharmacy, let's say it's 1g vanc and it's to be given q12, and has been given at 0500 and 1700 but I don't get the dose until 1900, I can through EPIC, set the new schedule to 1900, 0700.

I don't think it's a big issue that weight isn't used for more medications because there are MANY factors at play, notably renal function, that affects pharmacokinetics. And for a few meds, such as titrated cardiac drugs- it is. We program the pumps in mcg/kg usually. But otherwise, if a particular dose isn't giving a desired effect, let's say I'm giving 25 mg metoprolol BID, and they still have a high BP and pulse is still quite high, its too easy to call a doc and say "hey, can we up her to 50? This ain't cutting it". Or if I have to skip doses because the BP is too low, it's easy to ask if we can half it to 12.5 mg. Or of course introduce other meds altogether. And if it's something particularly dangerous like vanc or gent, we do troughs.
 
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I did not say that they acted inappropriately, I said that I do not understand.
"Must be very different indeed.." to me reads a little bit as an insult to our profession, given the context in which it was said.

So I'm a little confused here as to why you don't understand why an unstable patient may go to surgery if you've been an RN and are medically trained (given your username). You have a lot of gaps in your story and I'm not going to try and determine if your vet was right/wrong because it's not my place and I wasn't there. With that being said, common sense tells me that if a dog is already septic due to a limb infection, amputation right away may be the dog's best option for survival. It's not like human surgeons wait until a patient is perfectly stable before performing a life saving operation. Ideally every patient would be perfectly healthy, but then we'd never do anything but spays and neuters. I get having questions after losing a pet like that, but don't be afraid to discuss these questions with your vet instead of not doing that, and still being confused years later. Given that your vet had full knowledge of the case and what happened, you may have gotten some answers and closure.

Also, FWIW, even perfectly healthy animals undergoing elective OE/OHE can code while recovering from anesthesia. I've seen it happen to my own patients despite proper monitoring by machines, myself, and other experienced staff. Sometimes you just cannot get them back, and it sucks. Recovery is the most dangerous part of the anesthetic process. There are many physiologic changes happening at once. I imagine it's the same in humans.

You ask how long the techs I was referring to have been in practice...there are a lot of techs that leave the field within 5 years or so, but there are also a lot of techs that are lifers. IMO vets seem to treat techs better than MDs/DOs treat RNs (or at least from the stories my RN cousins have told). However, these same techs I know would never tell someone at a party 'Oh, just take your dog off this medicine if you don't like the side effect then.' I listened in horror as a family friend (RN) told my mom to just take my grandfather off his BP meds so he wouldn't get another gout attack. I've also seen a ton of RNs offer medical advice on FB, I can't recall a single time an RN told someone to go to a doctor. I'd estimate that a good 90% of the time, I see techs directing people to their vet's office. It just seems that so many RNs out there believe they are more educated/better qualified than a doctor to make those calls and give that advice. I have no doubt than an RN has the intellectual capacity to complete med school, but they didn't complete RN school to be able to diagnose and treat.

Human med seems to have a pretty big issue with class warfare, I just don't think vet met fights that battle to the same degree.
 
"Must be very different indeed.." to me reads a little bit as an insult to our profession, given the context in which it was said.

So I'm a little confused here as to why you don't understand why an unstable patient may go to surgery if you've been an RN and are medically trained (given your username). You have a lot of gaps in your story and I'm not going to try and determine if your vet was right/wrong because it's not my place and I wasn't there. With that being said, common sense tells me that if a dog is already septic due to a limb infection, amputation right away may be the dog's best option for survival. It's not like human surgeons wait until a patient is perfectly stable before performing a life saving operation. Ideally every patient would be perfectly healthy, but then we'd never do anything but spays and neuters. I get having questions after losing a pet like that, but don't be afraid to discuss these questions with your vet instead of not doing that, and still being confused years later. Given that your vet had full knowledge of the case and what happened, you may have gotten some answers and closure.

Also, FWIW, even perfectly healthy animals undergoing elective OE/OHE can code while recovering from anesthesia. I've seen it happen to my own patients despite proper monitoring by machines, myself, and other experienced staff. Sometimes you just cannot get them back, and it sucks. Recovery is the most dangerous part of the anesthetic process. There are many physiologic changes happening at once. I imagine it's the same in humans.

You ask how long the techs I was referring to have been in practice...there are a lot of techs that leave the field within 5 years or so, but there are also a lot of techs that are lifers. IMO vets seem to treat techs better than MDs/DOs treat RNs (or at least from the stories my RN cousins have told). However, these same techs I know would never tell someone at a party 'Oh, just take your dog off this medicine if you don't like the side effect then.' I listened in horror as a family friend (RN) told my mom to just take my grandfather off his BP meds so he wouldn't get another gout attack. I've also seen a ton of RNs offer medical advice on FB, I can't recall a single time an RN told someone to go to a doctor. I'd estimate that a good 90% of the time, I see techs directing people to their vet's office. It just seems that so many RNs out there believe they are more educated/better qualified than a doctor to make those calls and give that advice. I have no doubt than an RN has the intellectual capacity to complete med school, but they didn't complete RN school to be able to diagnose and treat.

Human med seems to have a pretty big issue with class warfare, I just don't think vet met fights that battle to the same degree.
I have honestly never had a problem with MDs, I think it's mostly a male/female thing. In 3 years I've never had a single patient complain or give me any trouble either, but really compassionate, good nurses I work with struggle every single day to get patients to trust them, take their meds, etc. I have to go in an convince them. Even at times when their nurse is a 20 year veteran nurse that knows way more than I do..


And the reason I didn't understand, is it just seemed to make more sense to use some IV antibiotics first of all, instead of just some PO amoxicillin, she had an ankle fracture which was splinted, and an infection plus amputation is a lot of stress on the body. And since she was already septic, how does amputating the limb help? The infection is already in her bloodstream, no longer confined to an extremity.

But like I said- I know I don't know everything, that's why I ask. I often ask my MDs why we do something a certain way, and that's how I learn.


Also- nurses do diagnose. We have to know what disease process is going on, or at least a good estimate, even before the patient is seen by a physician. And we write orders too. Every facility I've ever worked has functioned this way. We write the order, and the physician signs off on it later. We obviously don't do this unless we're sure. I usually write orders for restraints, oxygen, non narcotic pain medications in patients with no contraindications, tube feeding orders that have been suggested by a dietician if there are no contraindications, and several other things. There is an "order from a physician" but they don't know about it until later. If you wake up an attending in the middle of the night for a restraint order or needing some Tylenol, there are going to be major words. Usually there is an understanding with the physician before hand whether they're okay with you putting in orders in their name. At the facility I work at, ICU and stepdown nurses are pretty much trusted to do this with the exception of a few (actually pretty much one agency travel nurse that's special), and floor nurses are generally not trusted but some are.
 
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Also- nurses do diagnose. We have to know what disease process is going on, or at least a good estimate, even before the patient is seen by a physician. And we write orders too. Every facility I've ever worked has functioned this way. We write the order, and the physician signs off on it later. We obviously don't do this unless we're sure. I usually write orders for restraints, oxygen, non narcotic pain medications in patients with no contraindications, tube feeding orders that have been suggested by a dietician if there are no contraindications, and several other things. There is an "order from a physician" but they don't know about it until later. If you wake up an attending in the middle of the night for a restraint order or needing some Tylenol, there are going to be major words. Usually there is an understanding with the physician before hand whether they're okay with you putting in orders in their name. At the facility I work at, ICU and stepdown nurses are pretty much trusted to do this with the exception of a few (actually pretty much one agency travel nurse that's special), and floor nurses are generally not trusted but some are.
Well that's terrifying. And also (I'm fairly confident) illegal. I mean, sure, while they're taking a history they might come up with some thoughts of what disease process is going on, but there's no way they should be actually diagnosing a patient.
 
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Well that's terrifying. And also (I'm fairly confident) illegal. I mean, sure, while they're taking a history they might come up with some thoughts of what disease process is going on, but there's no way they should be actually diagnosing a patient.
It's how it works in most facilities. At least 4 that I know of and I'm sure these 4 aren't an anomaly. We don't make "medical diagnoses" but we assess a patient, and input "nursing diagnoses" which impact care. If a physician makes a medical diagnoses that contradicts what our nursing diagnosis, then obviously they overrule us. But we make initial nursing diagnoses and care is implemented based on what we diagnose. Nurses have a large impact on care, but we are state registered.


There are certain no gos like narocotics, etc, but we initiate many orders. Now of courde we are not autonomous. A physician is put under the order we input to epic. But we initiate many orders, not the physician. Even if they "started" the order. It's how the real world works.
 
It's how it works in most facilities. At least 4 that I know of and I'm sure these 4 aren't an anomaly. We don't make "medical diagnoses" but we assess a patient, and input "nursing diagnoses" which impact care. If a physician makes a medical diagnoses that contradicts what our nursing diagnosis, then obviously they overrule us. But we make initial nursing diagnoses and care is implemented based on what we diagnose. Nurses have a large impact on care, but we are state registered.


There are certain no gos like narocotics, etc, but we initiate many orders. Now of courde we are not autonomous. A physician is put under the order we input to epic. But we initiate many orders, not the physician. Even if they "started" the order. It's how the real world works.

Well, this explains why there are so many errors in human medicine.
 
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@thedrjojo (first doc I thought of) out of curiosity, is this common? Of course nurses/techs assess patients, but making diagnoses and putting in orders?

I would never have an LVT begin treatment on a patients because of their diagnosis or put in medication orders without my explicit prior approval. As much as I respect LVTs up the wazoo for their immense technical skills, no way.
 
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@thedrjojo (first doc I thought of) out of curiosity, is this common? Of course nurses/techs assess patients, but making diagnoses and putting in orders?

I would never have an LVT begin treatment on a patients because of their diagnosis or put in medication orders without my explicit prior approval. As much as I respect LVTs up the wazoo for their immense technical skills, no way.
Nurses don't put in official diagnoses, but there are many times it's pertinent for an order to be initiated without prior knowledge of a physician. Main insteances I can think of are oxygen and restraints. Physicians will be able to review these orders soon after, but they don't truly initiate them. Even if it "says so" in epic. They are simply initiated under their name. Often times you will see after they get to work that they will modify these orders as they see fit.
 
I mean I can see very, very VERY basic things like that. If you have a violent, flailing patient you need restraints, or a patient turning blue needs O2.

But not very much more than that. And certainly not diagnosing a patient - more like stabilizing a patient with limited information.
 
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Other than that, it's pretty limited. We definitely would never put in a narcotic order, carfiac meds, fluids, etc. maybe a Tylenol or something. Like I said it really depends on the physician. You develop a working relationship and they trust some people to put in (still very basic) orders.

Most often it's me calling the attending and telling them what i want. Roughly 90% of the time I get "sure that's fine/that's good let's also do x", 5% of the time it's "I don't know that patient tell the day shift nurse to get the doctor on days to do it" and 5% it's a "no let's do x instead."


And part of the care plan are nursing diagnoses. There's a big difference in a registered nurse and an unlicensed assistant such as a CNA or vet tech. I mean we purchase our own medical insurance, have to apply for state licensing yearly/biyearly, etc.
 
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Actually, no, I don't feel that they acted inappropriately. Like I said, I didn't understand. It's not the same protocol that we follow with humans.

Come on now. You know very well that this was an underhanded jab ("I don't know why they would have operated if she wasn't stable....") as well as vomiting your plethora of acronyms hoping that we wouldn't know what they stood for. You were questioning the doctor's choices while having limited knowledge of the case. Fact of the matter is, stable **** dying under anesthesia is not crazy uncommon - animal and human. It happens.
 
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Come on now. You know very well that this was an underhanded jab ("I don't know why they would have operated if she wasn't stable....") as well as vomiting your plethora of acronyms hoping that we wouldn't know what they stood for. You were questioning the doctor's choices while having limited knowledge of the case. Fact of the matter is, stable **** dying under anesthesia is not crazy uncommon - animal and human. It happens.
what? BKA or RLE?
I would expect being a medical professional you'd know those acronyms. (Below the knee amputation and right lower extremity) And no, I understand operating on an unstable person/animal to stabilize them, but I don't understand how treating septic shock with an amputation makes sense. But like I said, I don't know everything. That's just my limited understanding. Septic shock just seems much higher to prioritize than an amputation. Especially since she was already popping 105 temps.

I am questioning the case. Im not questioning the vets knowledge. There's a difference. I don't understand enough for it to make sense to me. Doesn't mean I think I'm right and the vet was wrong. I have this same kind of thing with patients that have less medical knowledge almost daily. I'm just not clear on it and that bugs me.
 
Vets have this thing about which other medical professionals make the worst clients because they think they know things when they actually do not. The top of the list are nurses.
 
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what? BKA or RLE?
I would expect being a medical professional you'd know those acronyms. (Below the knee amputation and right lower extremity) And no, I understand operating on an unstable person/animal to stabilize them, but I don't understand how treating septic shock with an amputation makes sense. But like I said, I don't know everything. That's just my limited understanding. Septic shock just seems much higher to prioritize than an amputation. Especially since she was already popping 105 temps.

I am questioning the case. Im not questioning the vets knowledge. There's a difference. I don't understand enough for it to make sense to me. Doesn't mean I think I'm right and the vet was wrong. I have this same kind of thing with patients that have less medical knowledge almost daily. I'm just not clear on it and that bugs me.

People here have already attempted to explain, but I'll go ahead and say it again - veterinary medicine is different than human medicine. BKA is not a veterinary medical term. Technically, the dog's "knee" is the stifle joint; most veterinarians I know only refer to it as the knee when trying to explain things to clients. And if you tried to talk about that joint as the knee to a horse person, you'd be on the wrong leg altogether. I've already mentioned the lower extremity thing - most people shorthand animal limbs as fore and hind,so RF/LF, RH/LH, etc.

If you have questions about what happened with your dog, I suggest you ask the treating veterinarian instead of speculating on an internet forum. It's certainly not clear to any of us what actually happened or what condition your dog was in based on your description (now you say she was in septic shock?). You admit that you don't understand the case, and that it bugs you. Instead of making presumptions, you could go to the source.

I certainly wouldn't feel comfortable making assumptions about how much of my medical knowledge applies to humans, because they are a species I have not been specifically educated upon. I would feel even less comfortable giving advice to someone on how to treat a human - in fact, it is illegal, because it is beyond the scope of our practice.
 
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what? BKA or RLE?
I would expect being a medical professional you'd know those acronyms. (Below the knee amputation and right lower extremity)
For a human medical professional, sure, veterinary medical professionals deal with animals, and quadripeds don't have "knees", they have "stifles". And quadripeds have two "right lower extremities" so we don't use that term because it's totally meaningless. In veterinary medicine we use ventral and dorsal, but in human medicine they use anterior and posterior. There are several differences in terminology, based either on the quadriped vs biped anatomy, or based on unique anatomy (like an LDA, a common term in large animal medicine that has no meaning in human medicine).
 
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what? BKA or RLE?
I would expect being a medical professional you'd know those acronyms. (Below the knee amputation and right lower extremity) And no, I understand operating on an unstable person/animal to stabilize them, but I don't understand how treating septic shock with an amputation makes sense. But like I said, I don't know everything. That's just my limited understanding. Septic shock just seems much higher to prioritize than an amputation. Especially since she was already popping 105 temps.

I am questioning the case. Im not questioning the vets knowledge. There's a difference. I don't understand enough for it to make sense to me. Doesn't mean I think I'm right and the vet was wrong. I have this same kind of thing with patients that have less medical knowledge almost daily. I'm just not clear on it and that bugs me.
If you had these questions, the right time to ask them was before you signed the consent form allowing any type of treatment, or when you got the awful news that your pup passed. Far too often, we spend tons of time explaining things as simply as possible to clients. We give them ample time to ask questions, and are happy to field any questions that come up the next day after they've thought about it for a while. We have no control over whether or not you're sitting there with a burning question that you won't ask us and later bringing them up on an internet forum.

Many human acronyms just don't apply to vet med, as Calliope mentioned. As a medical professional yourself, you should know that there are anatomical differences between animals (and physiological, and so on).
(like an LDA, a common term in large animal medicine that has no meaning in human medicine).
Quick, RN, google what an LDA is!
 
If you had these questions, the right time to ask them was before you signed the consent form allowing any type of treatment, or when you got the awful news that your pup passed. Far too often, we spend tons of time explaining things as simply as possible to clients. We give them ample time to ask questions, and are happy to field any questions that come up the next day after they've thought about it for a while. We have no control over whether or not you're sitting there with a burning question that you won't ask us and later bringing them up on an internet forum.

Many human acronyms just don't apply to vet med, as Calliope mentioned. As a medical professional yourself, you should know that there are anatomical differences between animals (and physiological, and so on).

Quick, RN, google what an LDA is!
Exactly. If I don't know what something is I'll google it. I would hardly except a couple of acronyms to baffle anyone.
 
I'm completely open to learning about some veterinary medicine. It's why I read this forum. It was my fathers passion, and from a young age of helping him sew our hog dogs back up after a hunt, or giving our animals ivomectin, etc it brings back good childhood memories. I wish he was still alive so I could ask him. He never became a vet but was very knowledgeable with a bachelors in ag and a bachelors in microbiology.
 
Exactly. If I don't know what something is I'll google it. I would hardly except a couple of acronyms to baffle anyone.
I think you missed her point.
 
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No, but making the point of accusing me of attempting to baffle people is absurd.
No, but you’re using very incorrect terminology for veterinary medicine and then being very rude when it is pointed out it isn’t correct.
 
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