do you always monitor BP b/f giving HTN medications

NotFlo · Jan 20, 2011

Check your facility policy.

First of all, in LTC, no, every patient doesn't need their BP checked before every BP med is given every day for the rest of their lives. Millions of people take BP meds at home without their BP being checked 3 times per day.

My facility has a policy. New admits are checked q shift for a week, q day if not on BP meds or before admin. of BP meds if they are on them for a month, then if stable can be checked q week and of course PRN for any reason. If not on BP meds and BP is stable MD okays BP to be taken monthly usually.

Any change in BP meds or addition of certain antipsychotics or other classes of meds that could potentially affect BP will result in an order to check BP q shift for a certain amount of time.

nursie_pants · Jan 20, 2011

Yes, I always take BP and HR before administering HTN meds. I work in a hospital on an oncology floor at we actually use an electronic MAR that prompts us to type in those values as part of our charting. You're running a pretty big risk if you don't check, administer HTN meds, and unwillingly drop a low BP even further.

INLPN93 · Jan 20, 2011

If a BP med is on the MAR without parameters: Take the BP, document it, and if its low just give the MD a FYI of the results.

Let them know there aren't any parameters and ask if they'd like some to cut down on calls from your facility.

Also, if you held it without parameters let the MD know that too.

Always assess for symptoms associated with hypotension just as you would with hypertension.

General E. Speaking, RN, RN · Jan 20, 2011

I'm not in LTC but in acute care so we do vitals pretty frequently. We always get a BP before giving a BP med. Sometimes there are perimeters by the doc as when to hold.

For the times that there isn't I see what the BP is running. If it is 90 or less, I would absolutely hold it. If it is 100 or less, I will see what their trend has been running. If this is their normal BP, I probably would give it.

I always assess the patient: if they have a lower BP- are they dizzy? lightheaded? What is their pulse? Low BP and high pulse could mean their body is trying to compensate for the low BP and further investigation is needed.

My thinking is: you can always hold it, call the doc and give it later.

Maybe a LTC nurse will have better answers for you as mine are geared towards acute care.

nursegreenbean · Jan 20, 2011

Thanks for replying so fast. I have not been shown a policy/procedure book but I am going to have to ask b/c I have other questions too.I guess I can understand both sides. I personally know people who are on BP meds at home and they don't take their BP b/f taking their meds. So why would some residents have the order and others not. Maybe their pressure is known to flucuate with highs and lows and the other residents are known to stay high? If I didn't have an order to take the BP b/f administering the med and it was low would I have to call the doctor before holding? Just want to make sure I am doing it right and we are due for state to come in. I wasn't sure if they would site me for not taking the BP if there was no order? :nono:

PhillyBSN · Jan 20, 2011

I work in a long term care setting and on a progressive care unit at a hospital. I always check my patients blood pressure prior to given any antihypertensive...especially the powerful vasodilators like Clonidine. If a patients blood pressure is low, you do not want to give someone Clonidine. You may find that individual on the floor. If there are no parameters, i would FYI to the doc and just double check. Some bps meds are more powerful than others. So better safe than sorry.

Hoozdo, ADN · Jan 20, 2011

Thanks for replying so fast. I have not been shown a policy/procedure book but I am going to have to ask b/c I have other questions too.I guess I can understand both sides. I personally know people who are on BP meds at home and they don't take their BP b/f taking their meds. So why would some residents have the order and others not. Maybe their pressure is known to flucuate with highs and lows and the other residents are known to stay high?

Well, it also depends on what kind of blood pressure medication it is too. For

example, beta blockers (usually the drug name ends with lol) knock the heart

rate down too. So you wouldn't want a beta blocker for a pt with bradycardia.

Different medications work in different ways. If a new or adjusted dose is given

then you want to take a BP. If you have time, always take a BP and HR before

giving any dose.

mentalhealthRN · Jan 20, 2011

Keep in mind there is a difference between a patient in an acute care setting and a resident in LTC. A patient in acute care is there because they are not stable, not well. A resident in LTC is stable, this is their home. Unless, of course, the resident becomes unstable. There are times when you would check before giving the med in LTC-when you have reason to beleive the BP may be higher or lower then normal. If the resident has been ill with N/V/D this loss of lots of fluids could lower the BP. Complaints that prompt a check. ie--you go to give the meds and ask a general assessment question of--how are you today? How are you feeling? If they say--well I have a headache and that last nurse gave me some tylenol but it still hurts--if they have HTN their BP could be up. If they answer telling you they are a bit lightheaded today and sleepy. You ask how they slept last night and they say-fine....lethargic, sleepy, lightheaded--I'd check that BP before I gave that med. So much of it is common sense.

And as far as the hold parameters. I had a nurse give a BP med and write down the bp that was like 72/40. She didn't write anything special in a note with an assessment of symptoms.....didn't call the doc.......GAVE the med and didn't even re-check the BP until like 4 hours later. She got fired as she told the DON--well there were no written parameters. She was told that it is expected she use nursing judgement and that the med should have been held and the doc called. Me, considering all the BPs charted prior were MUCH higher--like 130-140/75-90.....I would have sent the resident out to the ED and called the MD as an FYI! lol So cover yourself. You are an educated and licensed nurse and not a robot. You have to use your own judgement sometimes and the docs expect us to do that.

NurseStephRN · Jan 20, 2011

I work in a cardiac unit in a hospital and always take a BP before giving a HTN med. If it is low or falls within the parameters for holding I'll hold the med, but check the patient's BP in a few hours to see if I could give the med.

Forever Sunshine, ASN, RN · Jan 20, 2011

This is LTC.. the resident's home. Would they be whipping out a b/p cuff and stethoscope before taking their blood pressure at home. Absolutely not.

If a resident's blood pressure is usually high(we have a resident who lives at 160/90.. shes on every med known to mankind ..thats just her norm), I take it, .. if its a new admit I take it..

But for the little old lady whos been taking her b/p med for years and you see in her monthly vitals that her blood pressure is over 100 systolic.. I would just give the med.

Also if you look in the MAR and you see that its been held recently (past 2 days) due to low systolic .. that would also be a good sign to take the b/p.

systoly · Jan 20, 2011

In LTC, not always. If there aren't any specific orders, it should be covered under routine vitals. I also learned in school to hold dig for HR less than 60, but in reality received orders to give it anyway. Of course dig has such a half life that it's another scenario anyway.