When to hold meds

[SunshineDaisy, ASN, RN]

Ok, this seems to be the one part that confuses me. If the dr doesn't write parameters on BP meds, when do we know to hold them? Like I had a pt taking 2 BP meds, her BP was 120's over 40's and I was going to hold them, but my charge nurse said no, give them. Gah!! I get so confused! Thanks in advance for any advice.

[JustBeachyNurse, LPN]

What are the parameters for the med order? Most have "hold for systolic less than 120" or whatever the Prescriber feels is appropriate for the patient

[RNNPICU, BSN, RN]

All BP meds should have parameters that are specific to the patient. I would clarify the order and ask for parameters. If anything seems odd, like a diastolic of 40, to me would be concerning and would probably call the MD to ask for more clarity

[RN403, BSN, RN]

All BP meds should have parameters that are specific to the patient. I would clarify the order and ask for parameters. If anything seems odd, like a diastolic of 40, to me would be concerning and would probably call the MD to ask for more clarity

YES. What this poster said. Even though you may check with your charge, if you still have doubts, you should always call the physician to clarify. It is your license at the end of the day.

[ixchel]

Clarify and request parameters, definitely.

By any chance was your patient a dialysis patient? We get a lot of them on my unit and it seems diastolics that low are to be expected. I don't remember hearing that in school.

[Carpediem1012, BSN, RN]

We need to know our meds and parameters for holding. If in doubt, check a drug reference guide. Like another poster said, we are the last line of defence.

[NotReady4PrimeTime, RN]

I definitely wouldn't like that wide pulse pressure and I'd be on the phone ASAP. A diastolic of 40 is barely enough to perfuse the coronaries in a healthy person, never mind someone already on multiple meds. Better to ask the question you think might be "stupid" than to guess and be wrong.

[Meriwhen, ASN, BSN, MSN, RN]

Also, you should manually recheck any vital sign that is very or strangely abnormal, such as a diastolic of 40. Automated BP machines can be inaccurate at times, and it's possible that the 40 is in error...but you won't know unless you pull out the cuff and steth, and check it again.

[renardeau, BSN, RN]

It largely depends on the floor; in my hospital's cardiac floors alone, there are a lot of differences in nursing judgment. Not at all saying my way is the best way, but just as an added view from another hospital/floor---being a HF/VAD floor, we have specific parameters written usually. For some people who run low, I'll still give if systolic is over 90 (depending on the drug and dose as well) and the MAP looks good (>70).

Generally we see hold for systolic

When in doubt, I doppler the MAP, even on pulsatile non-VAD patients. Our BP machines are just old and janky; listening for the MAP on a doppler is easier than listening using a stethoscope with a manual cuff, IMO, if you have a doppler available to you.

[mynnurse]

please use your critical thinking skills, its your license on the line and go back and see if the previous nurse gave the meds and see what the BP readings were after, use your good judgement even if it means getting chewed out by the doctor. it is easier to bring a BP down than it is to bring it up because you overdosed them. nursing is a big mind game, not only or we physically beat down but we get mentally exhausted, which all equals burnout

[SunshineDaisy, ASN, RN]

Thanks for the replies. I did go ahead and hold that med. In looking back through his previous BPs he was more in the 130s/60-70s. His BPs after (he was Q4) had gone up, like 120/50-60s. I let the day shift nurse know as well. Also called the hospitalist and he just said that's fine to hold it :/