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- by nextdoorguy Mar 13So we have this patient who happens to be on micardis 40 mg. He usually takes it in the morning. So what happened was his bp was around 90/60. But when we checked later that morning his bp was 110-120/70. So we gave him his meds. Later that night he became hypotensive. He is being mad because we gave him his maintenance at a normal bp. Am i at fault?
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- Mar 13 by AnoetosQuote from nextdoorguyWere there any ordered parameters?So we have this patient who happens to be on micardis 40 mg. He usually takes it in the morning. So what happened was his bp was around 90/60. But when we checked later that morning his bp was 110-120/70. So we gave him his meds. Later that night he became hypotensive. He is being mad because we gave him his maintenance at a normal bp. Am i at fault?
- Mar 13 by suga_junkieOn my ward we generally withhold BP meds if the systolic is <120 so I wouldn't have given it with that BP. The doctors usually write this in the order though. We are expected to check BP and withhold if on the low side, regardless. As the previous poster asked, do you not have parameters for giving BP meds?
- Mar 13 by eatmysoxRNWe don't have parameters so I'll usually hold for systolic less that 110. However, I usually ask the patient if they check their pressure at home and if so what they would do for whatever the reading is.
If the patient was hypotensive the previous night and the mycardis was the only bp effecting med they received then I'd hold it to see what effect it had. The patient probably needs an adjusted dose.
Call the doc if you aren't sure. They'll start including parameters if they don't like receiving calls for it.
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- Mar 13 by AnoetosIt really depends on the med. Some meds are more "rescue" than others and some have other effects that have to be taken into account.
Beta-Blockers are a prime example, their inotropic and chronotropic effects have to be taken into account. I wouldn't give Metoprolol to a hypertensive patient with a very low heart rate, I'd look for another med, maybe an ACEI. At the same time, it's important to remember that many antihypertensives are maintenance meds and that for people who have taken them for a while, what is really important is maintaining serum levels; additionally, these people often have a working tolerance to their usual dose.
I probably wouldn't hold any maintenance med for a SBP greater than 110.
- Mar 13 by WeepingAngelI would have done the same as you, although I agree with other posters, parameters are very useful in this situation just to CYA. I'm not sure why the patient was upset - I thought the idea behind maintenance BP meds was to keep the BP within a normal range on a day to day basis. When I was orienting I discussed this with my preceptor - she said give the BP med when the BP is 'normal' because that is what is keeping them there. Just my 2 cents.
- Mar 13 by nextdoorguyI think the parameter was hold if dbp is less than 100 but i think the dr was referring to th sbp not dbp. I clarified that with a senior. Weeping angel we are ont he same page. I give it when it's normal. As long as it is not low.
- Mar 14 by That GuyDefine how he became hypotensive. What was his BP
- Mar 17 by nextdoorguyHis bp dropped to 90/60 then to 80/40. Dr discontinued the meds that night. He said it could be an underlying infection