I work in a mental health setting and I had a patient whose blood pressure was 89/something and the aide rechecked it and it was 91/something. There are no parameters in the order to say "Hold BP medication if SBP is <100" or anything. Most of the nurses in this facility will hold a BP medication when the SBP is <100. I will tell the patient, "We usually hold BP med if it is less than 100. Are you okay with that?" I held the med (in which is was okay with at the time) and told the NP about the BP. She wrote an order to hold AM dose and then resume. Anyway, I gave the patient a handout on the med earlier in the morning by his request and of course it says "Don't stop taking the medication without consulting the doctor" which concerned him. I explained to him that the NP is aware and that they will re-examine his medications and most likely recheck the BP in a little bit. But, the patient has issues with anxiety/paranoia and wanted to take it after reading the handout.
I guess my question is more of an ethical / legal question mainly. I know this will happen again and I just want feedback as to whether or not I went about this the right way? I followed the order but at the same time I worry that I was denying the patient of his right to take the medication. I usually ask patients if they are feeling dizzy, lightheaded when their BP is low, but I did not ask him this time. It is a low dosage of the BP medication. Of course it was explained to him while it was held. I just want to make sure I did the right thing for the patient - as I hope they will re-examine his meds with the other psych meds he is taking. WDYT?
Nov 29, '16
Unless there are written parameters to hold, you should call the provider to inform of your concerns and then follow their recommendations. For some, a systolic of that is good. If they are not symptomatic that is fine. I would also encourage you to recheck at a certain time afterwards to see if there are any changes which may indicate administration of the medication.
Dec 9, '16
I'd hold it. You can always give it on the next set. But yes, the proper answer is: get parameters.
Dec 11, '16
I usually hold it and recheck the BP and give it at a later time. If it's still low then I'll call. I typically do not like to hold beta blockers because cardiologists get a little ticked when nurses do that.
Dec 20, '16
Without knowing what med we're talking about and what his BPs have been ranging; I would have held it then called to get parameters or waited for the MD to do their morning rounds and talked to them about it -with new set of vitals- & get parameters.
If this is acute care we sre talking about the pt has no right to take medication-you got an order to hold so you were covered. This would be like saying someone admitted for Xanax abuse had a right to take the 10mg 8 times a day that they took at home.
They have a right to refuse but not to demand unsafe or not ordered meds.
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