when to hold blood pressure meds
- 0Jul 18, '11 by spicy1At what pressure do you hold your b/p meds? I had originally figured that I didnt feel comfortable giving if there under 110 systolic, but I had other nurses give at 103. Any general rule of thumb if no official doctors order to hold.
- 2Jul 20, '11 by turnforthenurseRNIt depends on the doctors orders and the patient. Sometimes the docs are good about writing parameters. For example, I had a patient on metoprolol and he wrote to HOLD if SBP <100 or HR <60. I would also backtrack and look at previous BP's/HR's and look at the MAR to see if the medication was given. Say if the patient is running 104/78, look at the trends. The BP meds may be keeping that blood pressure in that range - if you hold it they could rebound.
If you're really unsure and the doctor did not write parameters, I would call and ask. I had a patient who had a BP of 134/43. Pt was to receive metoprolol, 50mg of PO hydralazine (scheduled) in addition to isosorbide for angina, which can also drop your BP. I looked at the trends and the MAR to see if the meds were given in the past. They were, but the BP was higher. The metoprolol had parameters written on the MAR (HOLD if SBP <100 or HR <60) but I still called the doc and asked because of that hydralazine.
When in doubt, ask! Whether it's another nurse or calling the doc him/herself.
- 0Jul 25, '11 by AeternaGenerally, I hold if SBP <100 or HR <60. When in doubt, ask the MD (or if it's an AM med, I hold it for the time being and catch the doctor on their rounds). If they are borderline (i.e. SBP right on 100) and I'm not too afraid their BP will tank (i.e. if they are drinking well, have IVF, have a history of hypertension, etc.), I will give it but tack a note for the doctor on the front of the chart asking if they want parameters.
Also, if you have a patient who is on hemodialysis (we see a lot of nephrology patients on our floor for some reason), you will also want to know which meds to hold prior to dialysis (as the nephrologist will generally want to hold BP meds that day, although ours are pretty good about writing out parameters and such).
- 1Jul 25, '11 by llg GuideI am happy to see that so many people are recommending to check with the doctor and to look at the patient's usual patterns. As someone who has hypertension, it scares me to think that a nurse might withhold my meds when my BP is normal for me.
Anything over 120 for the systolic is too high -- so to consider holding the meds for numbers in the desired neighborhood of 110 doesn't make sense unless it is known that the patient doesn't tolerate BP's in that range. 110 is a great number for most people -- a sign that the meds are doing their job and keeping the patient in the desired range.
Yesterday evening, my BP was 87/56. What did I do? I took my 2 BP pills a half hour later, as always. That's lower than usual for me, but reading like 100/66 are quite common. I would hope that nurses wouldn't withhold my meds for numbers like that without checking with me first as to what was I used to tolerating and/or checking with my doctor.
- 1Jul 25, '11 by turnforthenurseRNQuote from llgYes...renal patients in particular have compensatory hypertension - they may be used to having a SBP of 150-180mm Hg. If you give them BP meds and their SBP drops to say, 110, they might not tolerate that. When in doubt always ask, whether it is the patient or the MD or look at the trends. If you call the MD, ask for parameters, and ask them when they want to be notified. Some MD's may tell you to not call them unless the pt's SBP is 80 or less.I am happy to see that so many people are recommending to check with the doctor and to look at the patient's usual patterns. As someone who has hypertension, it scares me to think that a nurse might withhold my meds when my BP is normal for me.
- 0Jul 26, '11 by Do-overI'll hold for a bit and re-check, but ultimately (unless we already have parameters) I want an order from the doc to give or not.
Ex - had a patient with SBP 92, toprol (forget dose) and NTP due at bedtime. Called doc (no parameters on either) - doc gave guidelines on the toprol (so it was held) but wanted the NTP even with the low-ish SBP (elevated trops, etc)
- 0Jul 26, '11 by Do-overAnother thought - picked up a patient awhile back, previous nurse held cardizem d/t low BP (90s I think). However, his heart rate had been consistently in the 140s (a-fib), which is why the cardizem was ordered that day in the first place. The initial dose was held and the doc wasn't notified... I re-checked the BP, had no concern there and gave the med. HR dropped beautifully.