Vital Signs and Medication

  1. I was having a chat at work to another nurse and we got onto the topic of early morning vital signs. She said that she does them before she gives out her medication and I said, I do them within the first couple of hours. She was absolutely horrified and said that it was a great concern that I didn't do my vital signs first. Personally, I think giving insulin prior to breakfast is a bit more important!

    When I asked why, she said if her patients had low blood pressure, then she would with hold their BP pills as we had a duty of care.

    I then said how does this theory work when it comes to patients who are on daily observations but have twice daily hypertensive agents. :chuckle

    She waffled under her breath about this point and became quite unpleasant.

    One of the other nurses said that patients don't do this at home and most of our patients have been on BP pills long term prior to coming on the ward.

    The thing is, I have just returned to hospital work after 6 years of working in a non hospital setting and she made me feel REALLY dumb. I asked some of the other nurses but none of them do the obs first thing for that reason.

    I just feel really yukky, she said things like "well I would have a problem working with you" and that "it is a great concern", wanted to know how long I had been out of Uni (I told her I finished in 1989 and she seemed even more horrified). I'm not going to say anything to her because she doesn't work on our ward but geez, I am mad and also, what do others think?
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  2. 13 Comments

  3. by   renerian
    AT the hospital we did ours before their medications even if it was bid and we wrote the result in if it was pertinent such as a new med or heart rate with dig and such.

    renerian
  4. by   New CCU RN
    Personally, even if just to save my behind in a court I'd be checking those vitals PRIOR to giving the med. You cannot hurt anyone checking more often... you can frin not checking often enough. The excuse that they dont check them at home is not vaild....... they are not at home!!!!! They are in the acute care setting and as a result, they are being monitored for acute issues.

    I understand how overworked nurses are and I don;t work in M/S, I am in ICU (where there are times that you are checking BPs q3 minutes)....however, I still would somehow find the time to check at the least a BP and HR.... If you don;t have time to do that, then your unit has a staffing issue that ought to be addressed and I would be documenting such to the manager.......
  5. by   Noney
    Yes, alot of patients have been on the same meds for years. However you have got to consider there is a reason that pt is in the hospital. The are many variable that could change the pt's bp. Does the pt follow there prescribed diet at home? If not just the change in less salt being used while in the hospital for example could change the bp. What about sepsis? What about pt's that have been "on their meds" for years but in reality don't take them for financial reasons? .....
    There are alot of variables to figure in, so play it safe and do the vitals first.
    Last edit by Noney on Jul 21, '03
  6. by   bulletproofbarb
    Thanks for your input. I asked our staff development nurse and she didn't feel it was necessary, nor did she teach that. All our very sick patients and new admissions are on 2 or 4 hourly obs and those that commence new medications for cardiac, we have an obs regime.
    She said the doctors were more interested in a trend and not a one off low BP and that as nurses we should be able to recognise a change in their condition (which a low BP would produce) rather than relying on a machine to tell us, and that we should be assessing the patients condition (with our visual observations/patients demenor) before we gave them their medications and I think that makes more sense.

    Also, she wasn't happy about people withholding a BP pill for a one off low BP because of the rebound effect of hypertension. Most people's BP is lower in the morning so she said if we followed this thinking we would be withholding drugs at a high rate.

    Interestingly, I asked some more people what they do and those who do their obs first said their reasons were "because once you miss out on the BP machine and thermometer, you'll be running late all day" , another said she does them first if she can because it's hard to do them once patients are moving between departments or being reviewed by allied health, plus other reasons.

    No one did them because of close medication times.

    We clarified the definition/range of low blood pressure and as low as 90/60 is okey for a one off and is more likely due to dehydration or other current problem, rather than long term effects of hypertensive medication.
    Last edit by bulletproofbarb on Jul 22, '03
  7. by   AndyLyn
    Barb,

    On my floor (medical), the vitals have been taken at 5 a.m., before we start at 7. I only take them again before 10 if:
    a. pt.'s showing symptoms.
    b. previous shifts have held BP meds for hypotension or have had to given a med for hypertension.
    c. it's a new med.

    Our pharmacy has also started including a place on the MAR for blood pressures and HR on certain meds, those I always fill in with current numbers.

    Have faith in your assessment skills, and don't let one person make you feel inadequate. Sounds like you did the right thing in talking with someone who could give you important information, instead of just taking what that one nurse said and dwelling on that! Wish I could/would do that more, and worry about what peers say and do less...

    Good question!
    Andrea
  8. by   casim02
    hey better safe than sorry.. i have know nurses to give bp med, insulin without checking their patient...we have some sorry cna at my job and i dont trust their vitals . so if i have to give bp meds i double check my own...
  9. by   New CCU RN
    Originally posted by bulletproofbarb
    Thanks for your input. I asked our staff development nurse and she didn't feel it was necessary, nor did she teach that. All our very sick patients and new admissions are on 2 or 4 hourly obs and those that commence new medications for cardiac, we have an obs regime.
    She said the doctors were more interested in a trend and not a one off low BP and that as nurses we should be able to recognise a change in their condition (which a low BP would produce) rather than relying on a machine to tell us, and that we should be assessing the patients condition (with our visual observations/patients demenor) before we gave them their medications and I think that makes more sense.

    Also, she wasn't happy about people withholding a BP pill for a one off low BP because of the rebound effect of hypertension. Most people's BP is lower in the morning so she said if we followed this thinking we would be withholding drugs at a high rate.

    Interestingly, I asked some more people what they do and those who do their obs first said their reasons were "because once you miss out on the BP machine and thermometer, you'll be running late all day" , another said she does them first if she can because it's hard to do them once patients are moving between departments or being reviewed by allied health, plus other reasons.

    No one did them because of close medication times.

    We clarified the definition/range of low blood pressure and as low as 90/60 is okey for a one off and is more likely due to dehydration or other current problem, rather than long term effects of hypertensive medication.
    Just FYI.... not all patients that are hypotensive display s/s of hypotension. I have had many patients that are talking to me, clear as a bell with no appearant signs of any distress. Their HR being 30 and BP 60/20.

    I still advocate for checking them. Even if the resource nurse said it was not necessary. Even if the patient has been on the med for a while. Often patients are not compliant at home and so when they actually get on a med regime at the hosp, it is too much of a med..... I have had a patient that went into cardiac standstill after recieving his regular dose of Verapamil. Fortunately, he was in ICU and on a cardiac monitor already so no adverse results in the end.

    As far as what to do with the numbers, it is a close call. Personally, I will call the doc if I think it should be held and ask them.... that way I can document whatever they said to do. You are right that not all meds should be held for a low bp... for example a heart failure patient on an "pril".... they need that med... and should be given that med even if their pressure is 88/60 ! That is where they live and if it is held they are at risk to go back into acute failure and perhaps buy themselves a trip back to the unit for CHF tuneup. But, again, I call the doc.... and verify. If they get mad for my calling... so what.....that is why they are on call!!!

    It seems to be the "prudent" thing to check the BP. Even if this resource nurse said not to worry, well.....is that gonna hold in a court of law, I don't think so.... Do it to protect yourself....and your patients...
  10. by   Rapheal
    I do vitals first. If vitals have been done 2 hours before a BP (such as a new, stable admit), I will give the BP med if the value is WNL.

    As for a doctor who does not want a BP med held for a low BP. That is their call and you will have protected yourself by documenting that the doctor is aware of low BP and wants the med administered.

    As for someone making you feel like you are stupid-shame on them. Don't let that person make you feel bad. Nursing is all about learning, and reevaluating how you do things.
  11. by   stella123 rn
    I ALWAYS check VS before administering meds. I always do vitals at the beginning of the shift and then in 4 hours. Med pass times are 1700 and 2100 so it works out just fine. We start out shift at 1600.

    ETA - As for withholding meds, that is the doctor's call and not mine. If it is the first time, I ask for parameters so I do not have to keep calling. It sure makes things easier.
    Last edit by stella123 rn on Aug 20, '03
  12. by   rileygrl11
    Bullet,.....

    Just to protect your license, I would do the V/S prior to giving the meds. You checked with the powers that be and even though they don't require it, I would CYA!!!!! I'm with New CCU RN on this one. It's not the higher ups who risk losing their license on this and better safe than sorry. And doing it this way isn't going against the policy, it is just not necessary as far as they are concerned.
  13. by   Marie_LPN, RN
    Our policy is to do vitals before the meds.
  14. by   starter-rn
    I would check v/s before administering bp medication.

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