Just a question!!

Sep 16, 2007 08:18 PM

by gt4everpn

So this resident in the LTC's BP was 90/40, he was on Tenormin(atenelol) and Diovan and he was also on Sinemet- which can also lower BP when it interacts with antihypertensives, the resident was alert and was able to communicate and state that he felt fine, unsymptomatic in general, but what would you guys have done with a low BP like this??

*jmgrn65* · Sep 16, 2007, 08:21 PM

Re: Just a question!!

Originally Posted by gt4everpn

So this resident in the LTC's BP was 90/40, he was on Tenormin(atenelol) and Diovan and he was also on Sinemet- which can also lower BP when it interacts with antihypertensives, the resident was alert and was able to communicate and state that he felt fine, unsymptomatic in general, but what would you guys have done with a low BP like this??

where does his bp usually run, if he is asymptomatic i would let the physician know so they can maybe make changes.

gt4everpn · Sep 16, 2007, 08:33 PM

Re: Just a question!!

His BP was usually 140/80-120/70-80, and he was always on these meds, but I know the elderly are very sensitive to medications, I was just sitting there trying to think up what I could've done!

nancykday · Sep 16, 2007, 09:00 PM

Re: Just a question!!

Originally Posted by gt4everpn

So this resident in the LTC's BP was 90/40, he was on Tenormin(atenelol) and Diovan and he was also on Sinemet- which can also lower BP when it interacts with antihypertensives, the resident was alert and was able to communicate and state that he felt fine, unsymptomatic in general, but what would you guys have done with a low BP like this??

I would hold the medication and notify the physician give him/her my assesment and see what the physician wants to do

gt4everpn · Sep 16, 2007, 09:17 PM

Re: Just a question!!

Actually his BP was taken after the meds were given, the resident was on 24hr report for something unrelated I believe and the cna took his BP after he got his meds and then told me his BP was low, I checked the BP twice and it was low, so I notified the charge, but I was just wondering what else you could do for a low BP, if it was critical care, flds would have been admin, but this is LTC and he was asymptomatic.

kiszi · Sep 16, 2007, 10:18 PM

Re: Just a question!!

90/40 is not a critical bp. Particularly if it was a one time thing, I would have done absolutely nothing beyond charting it. If the pt frequently had bp's in that range before giving bp meds, I would hold the meds in question (not sinemet however) and pass on to the doc what had been happening.

TeresaB930 · Sep 17, 2007, 01:28 AM

Re: Just a question!!

A low BP can also be indicative of dehydration....a big problem in LTC. Being that the Atenolol is a Beta-Blocker, the first parameter to look at would be his HR. Occasionally, the doc will list parameters for the BP meds.....ie Hold for bp <100 systolic....but apparently that wasn't the case here.

If it were me, if the pt. wasn't symptomatic, I would have made sure the HR was in target range, given the meds, and pushed fluids.

marjoriemac · Sep 17, 2007, 07:01 AM

Re: Just a question!!

I would inform the GP but if patient feels ok then leave it with him. Perhaps check BP regularly for a week to see if the meds are the problem.

fultzymom · Sep 17, 2007, 10:24 AM

Re: Just a question!!

I would hold the med et update the MD for a review.

Leslie

*deeDawntee* · Sep 17, 2007, 10:39 AM

Re: Just a question!!

I would have done a set of orthostatic pressures to be certain he doesn't become sycopal when standing. If there were orthostatic changes, I would have been more aggressive dealing with the situation. Also, definitely record and report the pulse and changes with that. If pt remained asymptommatic, I would have let the office know, during office hours, and let the MD decide and make adjustments based on your findings. I would definitely document everything though and make sure that if you didn't get a response from the Doc yourself, that someone did, so that there was closure to the situation.

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Just a question!!

Just a question!!

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