[NancyNurse08]

So, in NS they're teaching us to hold BBs if the systolic BP is less than 100. However, my Davis says only to hold if the AP is less than 50; no mention of BP. If you don't put the BP parameters on your med sheets for clinical, the instructors ALWAYS ding you for it. However, in clinical practice, witholding a BB for a systolic of less than 100 is not necessarily done. My understanding is that often it is more important for the patient to get the BB than to worry about hypotension (ie a heart failure patient). If the patient lives in a low range, then it's pretty normal to just give it.

Thoughts?

[Angie O'Plasty, RN]

I agree. If a patient lives in the low range, I usually ask the doc for parameters.

You can't go wrong calling the doc if you have a question about whether to give or hold. Sometimes the doc will decrease the dosage, sometimes you'll get parameters that can help make the decision easier and the medication administration more consistent.

[BBFRN]

It depends on where you're working. On our CCU, it's standard to hold for SBP <90.

[jmgrn65]

also they may need it for rythm control as well.

[llg]

As others have said, "When in doubt ... check it out." It's always a good practice to double-check any situation that is not clear cut.

As far as handling your school's paperwork, that shouldn't be a big problem. Note the situation and document that you checked with the staff (and/or physician) as appropriate to get guidance for how to handle the situation.

In real life, the best health care (nursing or medicine) is not practiced in a "strict recipe" fashion. At the higher levels of expertise, general principles are tailored to fit the specific patient. Only beginners follow concrete rules to the letter when it comes to treatment plans. Beginners and advanced beginners need those guidelines to keep them safe, but more experienced practitioners know when and how to modify those guidelines safely.

[NancyNurse08]

You all make sense. Glad to see my thinking isn't way out there. It's rough being a beginner!