Before giving: drug by drug
| Drug or class | Check before giving | Why |
|---|---|---|
| Digoxin | Apical pulse (full minute), potassium, digoxin level | Bradycardia and toxicity; low potassium increases toxicity |
| Beta blockers | Apical pulse and blood pressure | Bradycardia and hypotension |
| Antihypertensives (ACE inhibitors, ARBs, calcium channel blockers) | Blood pressure; potassium and creatinine for ACE inhibitors and ARBs | Hypotension, hyperkalemia, kidney function |
| Loop and thiazide diuretics | Blood pressure, potassium, sodium, weight | Hypokalemia and dehydration |
| Spironolactone | Potassium, creatinine | Hyperkalemia |
| Potassium chloride | Potassium level, urine output, kidney function | Hyperkalemia if not excreted |
| Warfarin | INR | Bleeding when the INR is high |
| IV heparin | aPTT or anti-Xa, platelets | Bleeding; heparin-induced thrombocytopenia |
| Insulin and sulfonylureas | Blood glucose; is a meal available? | Hypoglycemia |
| Metformin | eGFR, contrast studies planned | Lactic acidosis |
| Levothyroxine | Heart rate; TSH over time | Tachycardia from overreplacement |
| Methimazole and propylthiouracil | CBC if fever or sore throat | Agranulocytosis |
| Lithium | Lithium level, sodium, creatinine, hydration | Toxicity |
| Clozapine | Absolute neutrophil count | Severe neutropenia |
| Valproic acid | Liver function, platelets, ammonia if confused | Liver injury, bleeding, hyperammonemia |
| Phenytoin | Phenytoin level, albumin | Toxicity |
| Vancomycin and aminoglycosides | Creatinine, urine output, drug levels | Nephrotoxicity and ototoxicity |
| Opioids | Respiratory rate, sedation level, oxygen saturation | Respiratory depression |
| Benzodiazepines | Respiratory rate, sedation level | Respiratory depression |
| Magnesium sulfate | Deep tendon reflexes, respiratory rate, urine output, magnesium level | Magnesium toxicity |
| Oxytocin | Contraction pattern, fetal heart rate | Tachysystole and fetal distress |
| Statins | Lipids, liver enzymes; CK if muscle pain | Muscle and liver injury |
| NSAIDs | Kidney function, signs of GI bleeding | Kidney injury and bleeding |
When a value is out of range
- Hold the medication and notify the prescriber when the value is outside the ordered parameters, unless there is an order that covers it.
- Document the value, the action and who was notified.
- Never adjust a dose on your own.
Frequently asked questions
What should a nurse check before giving digoxin?
The apical pulse for a full minute, the potassium level and, when ordered, the digoxin level. Hold and notify the prescriber if the pulse is below the ordered parameter or signs of toxicity appear.
What lab value is checked before giving warfarin?
The INR. For most indications the target is 2 to 3.
What should be checked before giving potassium chloride?
The current potassium level, kidney function and urine output, because potassium that the kidneys cannot excrete builds up quickly.