Certainly the patient's usual BP in this case is about #1 on the "relevance" scale. I would have (& have) done the following: After the initial order to give the scheduled narcotic, I would not have called for a second MD/NP/other order until I had thought critically and looked at these factors...What was her HR? What was her typical BP & HR about an hour after the sched med every prior dose given? If she had the BP you described, had a HR anywhere below 85, stated in that range, AND I had the order backing up the med order already, I would document all of that info, give the med when due, and document a follow-up BP & HR one hour later. Chances are she would be doing absolutely fine, you were showing due diligence by ascertaining all of her "usuals", & I might also have documented a RR and SaO2...there would be no logical reason to hold the scheduled narc if all of her vs were wnl for HER, and they remained unchanged one hour after the fact. It is one of those "experience provides comfort and covering your a&$ provides safety" situations which luckily we don't see TERRIBLY OFTEN! Best of luck to you in the future! :0)
Jan 13 by canoeheadI would have given the oxycontin, but held any prns if the patient was falling asleep before I could get back. I'd give prns if she was awake and alert, even with the low BP. If a patient is asymptomatic with their low BP you can be much more confident, but if they are sleepy and slurring, or can't sit up, they need intervention.
Jan 14 by EquestrianRNCertainly the patient's usual BP in this case is about #1 on the "relevance" scale. I would have (& have) done the following: After the initial order to give the scheduled narcotic, I would not have called for a second MD/NP/other order until I had thought critically and looked at these factors...What was her HR? What was her typical BP & HR about an hour after the sched med every prior dose given? If she had the BP you described, had a HR anywhere below 85, stated in that range, AND I had the order backing up the med order already, I would document all of that info, give the med when due, and document a follow-up BP & HR one hour later. Chances are she would be doing absolutely fine, you were showing due diligence by ascertaining all of her "usuals", & I might also have documented a RR and SaO2...there would be no logical reason to hold the scheduled narc if all of her vs were wnl for HER, and they remained unchanged one hour after the fact. It is one of those "experience provides comfort and covering your a&$ provides safety" situations which luckily we don't see TERRIBLY OFTEN! Best of luck to you in the future! :0)