BP meds and parameters

Personally, I wish the docs would write orders for BP parameters on ALL meds with the potential to lower BP all the time. And if it's a patient who runs soft consistently, I have no problem calling the doc at the beginning of my shift and saying "Jane Doe in 808 is consistently in the 100's/50's, would you mind giving me some official parameters for her meds so that I can hopefully avoid calling you at a less convienient time?"

Digoxin...make sure pt's apical pulse is above 60. I would also check K level and dig level to make sure they are WNL.

I would hold BP meds if pt's sBP < 100 (unless that's their normal sBP)...but some nurses that I worked with will only hold them if sBP < 90.

I would check pt's HR too before giving any beta blockers as they drop the HR really fast.

Cardiologists don't often write parameters on my floor. They sort of expect the nurses to know the meds we're giving and to be able to think critically and know when it makes sense to hold it and when it makes sense to give it. One or two of our meds come with standardized parameters that are entered in when the med order is entered into the computer. Usually if the docs write parameters, it's because the parameters they want are outside of the usual, and they don't want to be getting phone calls.

Many of our docs write parameters to ensure the meds get given, not held. When you have a CHFer on the "cocktail" (ACEI, B-blockers, lasix, et. al.) many times they need the meds, even when it seems like their pressure will not support it. If it is a chronic med then the effect will be less dramatic than if it is a new med.

It's nice to have parameters to eliminate some of the gray areas that exist. I've seen parameters for beta-blockers, CCBs, ACEIs, hydralizine, nitrates, even lasix. Many times though there is some nurse discretion involved. For our post-op CABG/Valve patients, the holding limits for beta-blockers was SBP<90 and/or HR <50, more so that we would give the drug in light of lower pressures.

But back to your question, really anything that can change the hemodynamics could have parameters, but most often it comes down to nursing judgment.

Good luck,
Tom

HR<50? Wow, our CV surgeons have a hold for HR<70 on their standard post-op order sets. I've always thought that was a little high.

hr rate of 50 wow i would really hate to see co/ci and their uop....

People with HF might have a better CO with a lower HR because they need a much higher LVEDP to produce a good enough stretch on their floppy ventricle and give a decent SV.

You have to keep in mind that their pathophysiology means something different from their vital signs than someone who is "healthy".

Yes, and we can give them BBs even with lower pressures because they need the lower SVR. I tried to explain that to a patient with severe HF needing a transplant, whose SBP was 92 and our holding parameters were to hold for an SBP lower than 90.