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 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.

That's another good point. "Two minutes" to take a BP can easily turn into much, much more than that with some of these demented patients.

[Forever Sunshine, ASN, RN]

That's another good point. "Two minutes" to take a BP can easily turn into much, much more than that with some of these demented patients.

"Mary I need to take your temperature.. This goes under your tongue."

'WHAT IS THAT.. WHAT ARE YOU DOING.. NO NO NO.. YOU DIRTY LOUSE.. NO YOU DIRTY THING.. NOOO.. WHAT ARE YOU DOING.."

"I'm just taking your temperature.. "

Imagine the blood pressure.. lol. I wouldn't get out of there alive.

[LPNnowRN]

At my LTC facility there are some people with parameters listed and BP and pulse need to be written in the MAR. Those people DO fluctuate often--I have held many doses for them. The others who get their meds without any BP or pulse listed as needed in the MAR have been taking them for years and are usually stable. The poster who said to use your judgement is correct--is that normally stable person ill (in which case we would be taking a set of vitals q shift anyway)? Trust your instincts--do they look different, say they feel different? then get a set. BUT--there is no way I could complete e med pass on 35 people twice a shift and do two insulin passes, not to mention the treatments, orders, ect...if I stopped to take a BP on everyone with a BP med, LOL. LTC is different than acute care.