Blood pressure medication / checking blood pressure

[abeautifulmind]

Hello :) I am currently learning all my pharm about blood pressure medications (student) and am wondering since my time spent on a ward that not many people check blood pressures prior to administering morning blood pressure medication.

I am sure there is a reason for this, I am just wondering if there are CERTAIN BP medications that drop the BP or elevate it quite substantially and quickly that woudl merit a BP check prior to giving. Kind of like a PR check with Digoxin before administering.

[FLmed]

I am baffled when I see nurses giving BP/cardiac meds without getting a recent BP and HR assessment. We all worked hard to get our licenses and it can easily be taken away if we aren't being safe. Remember that even though people do often take their BP meds at home without taking a BP, that's on their watch. When you have them, they have been admitted into the hospital because they are sick. It's now on your watch. It doesn't take that much longer to slap a BP cuff on.

[AngelRN27]

I work in a LTC facility and our CNAs do not take vital signs. We must take a BP prior to administering any cardiac drugs, and the general policy is to hold for a BP of less than 100/60 (if either systolic or diastolic is below one of these values). We technically don't have to document a BP for diuretics, but there are no residents at the facility that do not take some sort of BP med concurrently with their diuretic, so BP is monitored anyway. My facility is pretty accepting of nursing judgement calls despite these pre-set parameters (i.e. if I have known resident John for two years and I know that he is extremely sensitive to his metoprolol, I can hold for a BP of 109/65 and not really be questioned). The only exception to this general practice is when the resident in question is an ALF resident. In this case they simply hand out meds as these patients are not requiring "skilled nursing care" and their medication is to be administered as if they were at home...

In an acute setting, I would not administer any cardiac/BP/diuretic meds without having a very recent, accurate BP.

[babyyoda]

Like they all said, always check BP and HR before the BP med, end of story. No, they don't always take their own BP at home, but better safe than sorry. Often there are parameters to hold a beta blocker or whatever if the SBP is

[babyyoda]

I would see if there could be education and policies administered that requires the CNAs to post or report the vitals as soon as they are obtained?

[MessyMomma]

Rule of thumb...you need to check the HR & BP for every BP medication no ifs, ands or buts.[/quote']

Same for me.

And we mo longer have "nursing judgment". If no parameters are specified, you must call the doctor before holding.

[fishingnurse]

Question. I am a new nurse and it seems I am always trying to decide whether or not to give a BP medication to a lower BP patient. Many times the patient has multiple BP meds. I take a BP and wonder. If there is one med, okay. If there are several it gets more complicated. (This post assumes no parameters given by doc). I asked one of the more experienced nurses one day and she said to go by the Rate Pressure Product. RPP she explained is multiplying the heart rate times the systolic BP. If the resulting number is above 6000 it is okay to give meds. If at or below, hold the meds.

I had never heard this before. Have you guys heard of this or used it? She said if the RPP is above 6000 the heart is perfusing well enough to give BP meds. Not sure about using this as a general guideline in the absence of parameters. What do you think?

[NYbabyRN, BSN, RN]

I have never heard of the Rate Pressure Product; I will have to research and read up about it.

[shantel1621]

Over the years I have learnt that a ounce of prevention is always better that a pound of cure. It takes no more that 5 min. to check a BP prior to giving these meds but, it will take you an entire shift to chase behind a pt. that you accidentally or otherwise made hypotensive. It just an overall unsafe practice and not worth the stress, paperwork, meetings, lawsuit and possible loss of my job should the outcome be unfavorable for such pt. I protect my license at all cost and sometime that include telling a provider that their orders are inappropriate for that patient and I'm sorry but I will not administer it. We all practice under a license and he/she could alway administer it themselves should they see it fit.

[Gabby-RN]

I think its important to use your nursing judgement. If you are unsure it is important to look at where the patients BP trends. I had a patient that consistently had a SBP 90-105. Nurses that were not familiar with her would often hold her Metoprolol, Diltiazem, and another medication whose name escapes me at the moment, because they felt her pressure was too low for the doses ordered. This would mess with her heart rate and rhythm. She tolerated her BP meds well with no adverse symptoms. Eventually a note was added to EMAR saying do not hold for asymptomatic SBP

[susumarie, MSN, NP]

I work nights (7pm-8am) on a med-surg/oncology floor. Vitals are taken q8hrs (always look at your pts trends); 0600-1400-2200. I give the night meds at 9-10pm & you must always take and/or find out from the PCA what the pts vitals are before giving a BP/HR med. At 530-6am if the BP/HR is very high or very low I will do something about it at that time, re-check it & endorse it. The morning RNs look at the 0600 vitals & if a pt has a BP/HR med they take their pts vitals again before giving the med.

[nynursey_]

I check the most recent recorded BP, especially if it has been done within an hour of the scheduled medication. If it appears low, or borderline low, I grab a dynamap and recheck the pressure to ensure I should actually be administering the medication. A great majority of the patients are on q4hr vital signs, so there is likely always a recent BP available. Additionally, I always make sure the patient understands signs and symptoms of hypotension, so that if their BP drops rapidly, they know to alert me to changes in how they feel.

[Jamiemain156]

I found this thread after my weekend working on a unit I hadn't worked before where I had 18 residents on BP/HR meds. (I work in LTC for a staffing agency. Im lucky enough to always be at the same facility but rarely the same unit from day to day, so I dont get to learn the residents like the full time nurses would)

As I was doing my medpass I started looking back in the charts to see if other nurses were in fact checking every residents bp/hr before administration and didn't find much documentation other than routine shift vitals. Only 3 of these orders included parameters set by the doc. So I began to wonder if there were certain bp meds that didn't require me to check or if there was a certain time frame in place where I could use previous vitals. That's how I ended up here and from what I am seeing there is no set in stone time frame so my questions are still unanswered.

I always try to check my own vitals prior to administration. However, on this unit I had 25 residents to administer meds to. 18 on bp meds. 3 residents to administer meds via tube. And 2 tube feeds to hang. (Lets not even get into if I actually individually separated these meds into 10ccs of water individually. Also I swear 2 of the tubes were the SLOWEST tubes I've ever flushed). So with all that said. I have 2 hours to pass my meds. One person here commented " it only takes 5 minutes to check a bp" so let's go with that. I have 18 residents on bp meds and I take 5 minutes to take all of there bp's, there goes 90 minutes of my medpass. Then let's assume it takes me 3 minutes to give everyone there meds (unlikely depending on what all needs given but let's go with it) so 25 residents minus my 3 tubes (those take longer) so 22 residents each at 3 minutes each that's 66 minutes. Now let's move to the tubes. Let's say it takes me 8 minutes to do these that's 24 minutes. So total after I take all bp s, give my meds and do my tubes it has now taken me 3 hours to do my 2 hour medpass and I am 1 hour out of compliance. And that is IF everything goes as it should , everyone is wide awake and ready and willing to be compliant, no coaxing needed, no emergencies arise and all my CNA s are available and I don't have to stop and help someone to the bathroom or on the bedpan or run for a fall alarm every other minute. I love LTC but sometimes it's unrealistic what one nurse can do.

Also let me add our CNA s don't take regular vitals on everyone every shift and my shift starts at 1500 and med pass at 1600, once I finish report, count, do a walking round, check my MAR and my TAR for my shift and gather everything for my medpass I'm lucky to start right at 1600. And that's fingers crossed nothing comes up in that hour that requires immediate attention/intervention.

I feel like our CNA s should be doing vitals at shift start. At least on residents taking bp meds. There were 3 residents the CNA s were required to get vs on for my weekend shift and there was no time frame they had to do them in. Just by end of shift (or so I was told by the CNA, I will be checking into that)

Suggestions?