checking BP before giving BP meds?

nyrn5125 · Mar 9, 2009

I am on a telemetry floor so if it was within the hour and the patient has not really changed activity since the last BP reading or if it's a good number then I can use it. If BP reading 90/50 but the med says hold for bp

Melina · Jul 14, 2009

I always do my own BP for pts on BP meds. What good is a 7am BP at 9am? BP can drop between those hours. Best to do your own. (and I don't have my UAP take the BP for me, I take it myself, right before giving the med)...
The way I see it is, its MY license on the line if I tank someones BP because I relied on an old BP, or I do harm because I gave a BP med even with a decent BP but a slow HR. And thinking about it, if you do give it with a decent BP but low heart rate, aren't you in a sense practicing medicine without a license? Because you are, in fact, going against the docs order.
Just my from a new nurse.

I totally agree. If there is an order to hold a med for parameters, then the med should be held. If we have an issue with the order, we need to speak to the doc. I also think you should take your own BPs any time it could be a concern. I worked as an aide during school, and I know how important they are, but I have also seen a lot of bad BP techniques used. Wrong sized cuff, taking the reading while the pt is on his side, etc.

~Mel

nurse_becks6 · Aug 13, 2009

Also remember that even though there may not be parameters mentioned for holding the medication, you should still check the BP/HR and question anything that would typically fall below a standard parameter. Dr's don't always remember to include parameters and that's where your critical thinking skills kick in. I'm a new Med Surg Nurse and learning more and more every day. A few weeks ago I had a patient that the Doctor directly ordered a medication that was being given to verify a possible allergic reaction. Doctor stated "give this medication at noon and call me with any adverse reactions." It happened to be a BP medication, Dr didn't include parameters as this was a controlled allergy test.....being a new nurse terrified of possible allergic reaction to pt totally forgot about checking BP....patient's BP bottomed out, was symptomatic etc. Dr contacted and fluid bolus helped regain stable BP, pt recovered well but I didn't forgive myself for a week.....I'm slowly learning not to beat myself up, take things as slow as I can and ask lots of questions.

You live and you learn...now I ALWAYS check BP/HR prior to medication admin. no matter what and I do them myself in the event they don't coincide with previous data. If taking an extra measure will only improve pt outcomes and care than do it, might mean a few more minutes (that you don't have) but in the end you'll be thankful you took the time.

KaliNurse · Aug 13, 2009

Yes. You really should check prior to administering meds. Even though some patients have been on those same meds at home for the last 20 years and don't check their own blood pressure prior to giving themselves their meds.....you should still check because the patient is in YOUR care now!

When talking about parameters...you should know whether you are giving a beta blocker versus an ACE inhibitor. ACE's won't affect the heart rate...they only affect the BP. Beta blockers will affect both. So, you need to pay attention to what you are supposed to be giving, and as well as the parameters. If the patient's heart rate is 50, and their BP is 180/90, then call the MD and let him know about it since he is the one who ordered parameters. Most likely, he/she will change the classification of the drug ordered in order to lower the BP without affecting the HR.

By the way....pay close attention to your diuretics as the others have told you! Lasix or Aldactone in combination with a blood pressure medication, could certainly "bottom out" your patient.

MedSurgeMess · Aug 16, 2009

I've held meds, called MD to notify, only to have them say "give it anyway". Why bother writing parameters. Come to find out in our system, our pharmacy has most of these parameters automatically entered, so they will appear regardless. And the pharmacist will not take them out of individual records, says it takes too much time

Kittyfeet · Sep 3, 2009

I am a new nurse and I still ask my preceptor & charge nurse what they think when I'm worried. They usually say do a manual BP and apical pulse instead of going off the automatic results. And yeah, it def. could have gone up between 7 and 9. I used to hold everything for a little while and recheck later and their BP would always go way up after I did that. A lot of times their BP is low cause they were sleeping or laying in bed.

I am still waiting on perfecting that judgement! But I always feel a little more comfortable with an apical pulse if it's under 60. If they are on Tele I'll check that too.

Virgo_RN, BSN, RN · Sep 3, 2009

do you guys always check BP before giving BP meds?
Because on my unit, for 9am meds, nurses go off the 7am VS.
Also, if there are parameters such as "do not give is SBP is
some nruses would say "don't give it because HR is low", and other nurses say, "you should still give it because their BP is high and it helps stabilizes the BP and especially if they are a-fib or have any heart problems--THEY STILL NEED IT"
what do you guys do? follow one or the other parameter or still just give it because they have heart problems despite the BP and hR?

Yes, take BP and HR prior to giving cardiac meds, and follow holding parameters.

Having said that, this is where you need to know your meds, and understand the reasons you are giving them. It drives me bonkers when people refer to all meds that can affect BP as "BP" meds, when in reality, the person may be taking it for rate control, as an antianginal, or to prevent myocardial remodeling post MI. Does the person have multivessel CAD? Do they have cardiomyopathy with a low EF? Aortic valve stenosis? A history of SVT or A-Fib with RVR? Do they have a pacemaker?

In the person who has A-Fib, their BP is more likely to plummet if they go into a rapid rate than it is to be high, and they are more likely to be getting a beta blocker to control their rate than to control their pressures. A missed dose can result in a rapid rate and associated chest pain/pressure, dyspnea, dizziness, and other signs of poor perfusion.

A rate in the 40s does not automatically buy a person pacer pads, as some people live in the 40s and tolerate it just fine. Some people even dip into the 30s regularly while they sleep, and it's okay. That's how they live. How do you know they are tolerating a low HR? You assess them for s/s of poor perfusion. You can also ask the patient about it; many patients with a cardiac history are well aware of their rate/rhythm issues, and can tell you if a low HR is normal for them.

Some people with multivessel CAD will experience chest pain if they skip their beta blocker.

People with a low EF benefit from lower than normal systemic pressures, and an SBP of 120 could easily be considered hypertensive for them.

If the person has a pacemaker, then you can still give the beta blocker because the pacer will pace them if the rate gets too low, or they may already be paced right at 60 (it's not unusual to get a reading of 59 on the pulse ox) and you can't drop their HR even if you wanted to.

Another thing that makes a difference is whether the person has been on this med for fifteen years or if it's a new prescription, or if they've had a recent change in dosage.

Remember that even if a person has a low BP, they can be perfusing their vital organs just fine with a MAP >60.

If you are not working on a cardiac floor and do not have a good working knowledge of these medications and their indications for use, then by all means, follow the holding parameters and call the doctor. However, keep in mind that if the doctor tells you to give it anyway, it isn't necessarily because the doctor doesn't care about the patient or doesn't care about your license, it very well could be because the patient has a cardiac condition that warrants giving the meds even if the result is a vital sign that is outside normal parameters. A doctor worth his or her salt will ask you if the patient is symptomatic, so always assess your patient before calling the doctor with a BP or HR that is not WNL. :redbeathe

I should add to this already lengthy novel that as a Med/Surg nurse, you do not need to be making the clinical judgment calls mentioned above. Experienced cardiac nurses have a greater knowledge and experience base in this area, and are often given leeway by cardiologists to make these types of clinical judgments. The above is simply for the purpose of helping you understand why a person might need a med despite VS that are outside normal parameters. Always take your VS prior to administration and follow your holding parameters and notify the physician.

amandie24 · Sep 10, 2009

This is the good thing about being a baby nurse - paranoia. I ALWAYS check my pt's vitals myself prior to giving any BP med

mimilinda77 · Sep 29, 2009

I try to check BP's and HR's myself when I have patients on several cardiac meds...however if the patient has been hospitalized for a few days I will most certainly look at the bp and heart rate trends. Also having a strong understanding of the mechanism of action (and interaction) of diverse cardiac meds will make you feel a bit more secure when administering them. Why are you giving the beta-blocker or ace inhibitor instead of the arb or the calcium channel blocker? Most nurses will learn over time that cardiac conditions can be very complex and require several meds to achieve cardiac stability...getting the right dosage and combination can take a long time...and most doctors appreciate any feedback or alert that they get from the nursing staff in adjusting a cardiac patient's medications.

hoyt69 · Oct 3, 2009

ALWAYS ALWAYS ALWAYS take BP and HR before giving BP meds. And you follow what the doctor wrote for parameters NOT what another nurse thinks you should do. If there is doubt you can always call the doctor with your concerns about giving or not giving the med. Who cares if they get upset with your call, they would be alot more upset if you sent the pt. into a code blue. And it is YOUR license, protect it and have peace of mind that you gave the med correctly.

elprup, BSN, RN · Oct 10, 2009

Yes. You really should check prior to administering meds. Even though some patients have been on those same meds at home for the last 20 years and don't check their own blood pressure prior to giving themselves their meds.....you should still check because the patient is in YOUR care now!
When talking about parameters...you should know whether you are giving a beta blocker versus an ACE inhibitor. ACE's won't affect the heart rate...they only affect the BP. Beta blockers will affect both. So, you need to pay attention to what you are supposed to be giving, and as well as the parameters. If the patient's heart rate is 50, and their BP is 180/90, then call the MD and let him know about it since he is the one who ordered parameters. Most likely, he/she will change the classification of the drug ordered in order to lower the BP without affecting the HR.
By the way....pay close attention to your diuretics as the others have told you! Lasix or Aldactone in combination with a blood pressure medication, could certainly "bottom out" your patient.

Thank you - such great information for us new grads!! This one is definitely going in my nurse note book. Thanks