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?
Jul 21, '03
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
Jul 22, '03
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
Aug 20, '03
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