do you always monitor BP b/f giving HTN medications

[nursegreenbean]

I am a new LPN working in a LTC facility. In school we learned that you are suppose to take the residents BP before giving any medication for HTN. I've noticed though in our MAR that for some residents there is an order written to check the BP b/f giving, a place to document it, and parameters for when to hold it but for other residents this is not in the MAR. So my questions are: do you as the nurse just know to take the BP b/f giving all HTN meds using your judgement as to when to hold it , if it was low would you call the doctor b/f holding it OR are we only responsible to take the BP, record it, and hold it if there is a written doctors order in the MAR.I tried to ask this question and a couple others to an RN whose been at the facility for several years but it didn't go so well ( thats a whole other thread in itself) so I thought I would turn to you. Thanks for your input:)

[NotFlo]

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.

The original poster is in LTC. You can't compare how often you take BP in an acute care setting with how often you take BP in a long term care setting.

[Yosemite, RN, ASN, EMT-I]

It would never occur to me to NOT check blood pressure before giving such a medication, yet I can see how checking the blood pressure before passing medicaitons for 40 or more people would be a, um, "challenge."

Sounds like a bad situation to be in.

[Forever Sunshine, ASN, RN]

It would never occur to me to NOT check blood pressure before giving such a medication, yet I can see how checking the blood pressure before passing medicaitons for 40 or more people would be a, um, "challenge."

Sounds like a bad situation to be in.

That is also why we can't take a b/p on everyone who gets blood pressure medication.

[ComeClarity]

Good question, OP. I just finished my final LPN clinical rotation in a nursing home and I noticed that some of the residents receive anti-hypertensives but don't get BP checks q shift/qd, and others do.

I think it takes us aback because in nursing school it's BEATEN into our brains to take the blood pressure before administering any anti-hypertensives but obviously that's more applicable to acute care settings than LTC, where residents may be taking the same anti-HTN med for YEARS. I would say though, if you're even in doubt, just take the extra time and get their BP.. better safe than sorry.

[CoffeeRTC, BSN, RN]

That is also why we can't take a b/p on everyone who gets blood pressure medication.

Thanks. This is a LTC question so the answers should take into consideration that. Having just about everyone get a HTN med or diuretic etc..25 bps would take forever.

If they have the paramaters and space to take it..it probably was written as an order and should be done. I would go thru and see who has these written and go over it with the doc.

Always use your nursing judgement too.

[jnrsmommy]

I work in a skilled rehab unit, and I also pull some shifts on our LTC side. We have paramaters on everyone that is on BP meds, and yes, the BP is taken every time.

Because they wouldn't check it every time at home and this is their home now, or you have 40 other residents to tend to is not gonna CYA should something happen.

[delilas]

I think LTC is a much different beast than the acute care settings (which is where the majority of the responders are residing). The LTC I worked in didn't really care unless it was a new admit, but then, this was also the facility where the residents were surprised when I took an apical pulse before giving digoxin, because no one ever had before

But in the end - its two minutes of your time, it's CYA, and there is no harm to checking it. If nothing else (if you have a dynamap or other automatic bp cuff), hook it up and get the numbers while you prepare and/or give any other meds.

[wooh, BSN, RN]

But in the end - its two minutes of your time, it's CYA, and there is no harm to checking it.

2 minutes for how many patients? How many LTC patients are NOT on some sort of hypertension med? There goes an hour or so of your day if you take a BP on every patient before giving a BP med.

I take a BP med. Believe me, the q week or q month that LTC regularly gets BPs is more often than I check mine. Of course, if I feel like it's off, I'll check it. As would a LTC nurse if a patient was showing s/s that the BP is off.

[delilas]

I could say the same thing and not take an apical pulse before giving digoxin. I have too many patients, I don't trust my techs vital signs, she's always had a normal rate before, so no big deal, right? S/s may not show immediately if it was not a sudden or steep enough drop. I had a patient who existed just fine at 90/60, but her meds weren't to be given systolic

There's a lot of if's and but's to not taking a bp before an HTN med, and most of the time, there's not going to be a lot of harm in not taking it. But should you? Yes.

[Forever Sunshine, ASN, RN]

I could say the same thing and not take an apical pulse before giving digoxin. I have too many patients, I don't trust my techs vital signs, she's always had a normal rate before, so no big deal, right? S/s may not show immediately if it was not a sudden or steep enough drop. I had a patient who existed just fine at 90/60, but her meds weren't to be given systolic

There's a lot of if's and but's to not taking a bp before an HTN med, and most of the time, there's not going to be a lot of harm in not taking it. But should you? Yes.

Yes you should.. in a perfect LTC world.

If the CNA's vitals look fuzzy I just compare them to monthly vitals sheet.

I don't like our dynamaps not one little bit. What I do like.. is.. those wrist cuffs. :) I test it on myself first to make sure its giving accurate numbers before using it on the patient. They are great for the confused little old ladys who are sundowning. If I came up to them with a blood pressure cuff and a stethscope they would probably beat me lol .. and dynamaps go too tight for their tiny arms.

[Blackheartednurse]

Well the hospital protocols usually require nurses to check the patient's BP before the administration of the BP meds,I work in a home health care setting and this type of nursing is a completely different world.I only see my patient once a week and most of them take BP meds by themselves and they never take their BP right before it.

[NotFlo]

I think LTC is a much different beast than the acute care settings (which is where the majority of the responders are residing). The LTC I worked in didn't really care unless it was a new admit, but then, this was also the facility where the residents were surprised when I took an apical pulse before giving digoxin, because no one ever had before

But in the end - its two minutes of your time, it's CYA, and there is no harm to checking it. If nothing else (if you have a dynamap or other automatic bp cuff), hook it up and get the numbers while you prepare and/or give any other meds.

Two minutes of your time? Multiplied by an average of 30 patients out of 40 that are on anti-hypertensives and you are spending 80 minutes, that's over an hour of a med pass that the state says can take no more than TWO HOURS just taking blood pressures...

And Dynamaps? Auto BP cuffs? LOL. No LTC I have ever worked with has such things. You're lucky if you can find a manual cuff...if you can find a standard adult size try finding the pedi or large size for your patients that need them. You're better off buying your own and bringing them in because they constantly disappear.

It's simply not possible, or necessary, in a LTC setting to take everyone's BP before every dose of BP medication. Our doctors understand this which is why they worked with the DON to develop the standing orders and protocol for taking BPs we now have. If a patient isn't stable for whatever reason they will write parameters and orders for how often the BP is to be taken and for what duration of time before we can go back to weekly checks or whatever.