Advice: On An MD Order

Nurses General Nursing

Published

Ok so I was taking care of this pt, without giving too much info, his systolic pressures at night usually are 90-100 systolic maybe once or twice he'll drop to systolic of 80s (which I watched but dont like), but his MAP stays above 60s. I was off a few days and started taking care of him again and the nurse told me that his systolics has been 70-80 with MAPs consistently in the 50s. When asked what the MD order she stated, that they were aware and didnt want to do anything. The MD was on the unit so I trended the bp for her to see and she said, not to page her unless it "stays below a MAP of 50 for a while." At one point systolic even in the 60s at times, she said its fine. I didnt feel comfortable with this, MAPs of 60 ok I can deal with this but less than 50?????? and what is for a while? Anyone know of research that support of MAPs less than 50???? What are your thoughts on this?

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Specializes in Emergency.

Is the pt symptomatic?

In any event, document, document, document.

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patient denies Headache or lightheadness, but it a renal pt, I documented everything they said when I tried to get orders and talked to my nurse manager about this as well. But they Drs were mad and wanted to give dilt metop and viagra and ami, with pressures that low and dialysis, I was concerned for the pt. My words fell on deaf ears.

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Specializes in CCT.

If they deny symptoms and their vitals, UO, skin signs and mental status otherwise indicate good perfusion it's fine. Try not to get hung up on numbers too much, try to judge overall perfusion status.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Viagra? Really? Why are you giving Viagra? Does that help dialysis in some new and undiscovered way? :smokin: What kind of facility is this and how are you monitoring the MAP? A line, automatic cuff, or manually with a calculator.

Some cardiac failure type patients require certain meds as pre-load, after load reductors and require the effects of the meds even with low MAP's.

I'm not buying this nor the Viagra....:cool:

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Specializes in Acute Care Cardiac, Education, Prof Practice.

i have given viagra to women several times for difficult to control blood pressures.

as far as the meds, there are no parameters on them?

"sildenafil under the name viagra is used to treat erectile dysfunction (impotence) in men. another brand of sildenafil is revatio, which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women. do not take viagra while also taking revatio, unless your doctor tells you to.

viagra may also be used for other purposes not listed in this medication guide."

http://www.drugs.com/viagra.html

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
i have given viagra to women several times for difficult to control blood pressures.

as far as the meds, there are no parameters on them?

"sildenafil under the name viagra is used to treat erectile dysfunction (impotence) in men. another brand of sildenafil is revatio, which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women. do not take viagra while also taking revatio, unless your doctor tells you to.

viagra may also be used for other purposes not listed in this medication guide."

http://www.drugs.com/viagra.html

my bad!!!!! one of the few times i don't look something up...:lol2::o i guess i have been out of icu longer than i thought. interesting.....i stand corrected and have something new to research...thanks!

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Specializes in Acute Care Cardiac, Education, Prof Practice.
MY BAD!!!!! One of the few times I don't look something up...:lol2::o I guess I have been out of ICU longer than I thought. Interesting.....I stand corrected and have something new to research...Thanks!

Well it is definitely a rare occurrence :)

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I had to look revatio up myself when I had a patient taking the med and the family also called it viagra. That is when I found out that it is prescribed for pulmonary hypertension. Surprising for me.

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Specializes in CCT.

It was originally developed as a pulmonary hypertension med. The subjects in the trial just reported a "happy" side-effect, leading to it's other, more popular use.

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Specializes in Acute Care Cardiac, Education, Prof Practice.
It was originally developed as a pulmonary hypertension med. The subjects in the trial just reported a "happy" side-effect, leading to it's other, more popular use.

I am trying to remember if they talked about that in "Love and Other Drugs" with Anne Hathaway. I am thinking it was mentioned somewhere in there.

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Specializes in TSICU, Renal Transplant, IR, Cath Lab.
:lol2: I gave cialis last week to a female pt with essential pulmonary HTN. I had to look it up to satisfy my "what the ???" reaction, but when you think about its mechanism of action, it makes sense.
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