CHF & low BP (hold BP meds?)

[RNinRubySlippers, BSN, RN]

Hi there,

Thought I would come ask the experts re: when to hold BP meds if BP low in CHF. We frequently run into this on our ward and I know most times, Docs want the med given to manage the CHF and do not worry as much about the BP. WHat are your thoughts re: the same and when DO you hold BP meds?

Just looking for some insight.

Thanks so much!

[agent66]

Hi there,

Thought I would come ask the experts re: when to hold BP meds if BP low in CHF. We frequently run into this on our ward and I know most times, Docs want the med given to manage the CHF and do not worry as much about the BP. WHat are your thoughts re: the same and when DO you hold BP meds?

Just looking for some insight.

Thanks so much!

The unit I work on we generally get an order to cover if the BP is a concern. Most of these patients don't have a blood pressure over 100 on a good day anyway. The docs always say is the patient symptomatic?? These guys really need their meds so it is not uncommon to see a "hold only if SBP

[ohmeowzer RN, RN]

thank you agent 66 for explaining that , i get so nervous when giving b/p nmed when the systolic is running below 110/ but you made me feel better about giving it. your reply was very helpful... how often do you look at the diastolic when giving the b/p meds ? and how low would you not give it for CHF?

[agent66]

Kizzykat, i must clarify that our patient population generally runs with a low BP to start with , if your patients are running 110 syst and higher then i would definatey call if they were below 100. Always look at the patients own trend and compare, and how are they feeling? If they have no get up and go, lightheaded etc then that warrants a call as well. Many of our meds we give in cardiac affect the blood pressure but are not necessarily given for that purpose, ie the lasix, the beta blockers. To me is always good to have parameters because often as you all know it takes awhile for docs to get back with an order and then you are behind with the meds..

[ohmeowzer RN, RN]

agent 66 you are awesome.. thank you for clarifying...

[al7139, ASN, RN]

Hi,

On my unit, most docs give parameters for specific meds such as Coreg or NTG, or Lasix. Usually it is to hold if SBP is less than 90 or apical pulse is less than 60. I have had instances where I have held the meds if the pt is close to but not quite at those parameters. I try to get a feel for their trend, ask them or family what the B/P is at home (lots of our pts DO monitor at home), and what other disease processes they have (for example: a pt with low B/P and a history of DM with low B/P and low blood sugars...I'm NOT giving HTN meds). Lots of times if I get a pt in report who has been trending low, with no parameters, I will call the doc to get parameters, because I would rather bother a doc who is having dinner with his family than call them at 11pm to tell them their pt bottomed out. I have held meds without parameters, I just make sure to document, and let the Clin II know. I have never yet had an MD get upset with me for it.

Amy

[newtelenurse]

Hi,

You can always ask them if it is a home medication. If it is something that they have been taking for some time then odds are they can tolerate it. Also, as others have stated, usually their BP run on the low side. Check the graphics or you can ask them. Some know what is "normal" for them some don't. If you give it and you are concerned simply check them 1/2 to 1 hour.

[SuesquatchRN, BSN, RN]

We generally hold for less than systolic 100 IF it is being given for BP. If it is for HF the parameter is based on an apical below 60 or 50. The dosages for HF are much lower than for BP and the patients need the inotropic action of the meds.