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Blood pressure medications

Joy101 Joy101 (New) New

So basically my patients BP was something like 92/52, and they were scheduled to get a beta blocker (metoprolol), I told the charge nurse, and they said that metoprolol only affects pulse and the blood pressure is not effected, so to give the metoprolol.

I know that beta blockers primarily effect pulse (my patients pulse was in the normal range), but they also have an impact on the blood pressure, (lowered pulse can lower BP indirectly),

so what I am asking is it safe to give metoprolol with low BP, BUT stable pulse?

Beta blockers do have an effect on bp (you are correct), some greater than others. Questions I would ask myself before giving the metoprolol 1) is this the patients normal bp 2) has this patient been in this dose of metoprolol for a long time or is it a new dose 3) what other medications could affect the bp am I giving at the same time?

Metoprolol is usually prescribed after an mi or hf, so it's pretty important to receive. If the answers to my first two questions were yes, I would give it and check the bp two hours later. If they were receiving other medications which would also decrease bp, I would stagger them so the patient gets them without a mass drop in bp. If the low bp was new and/or the dose new, I would probably do a full assessment then discuss with the doctor before giving it to make sure something doesn't need to be changed, I also find it helpful to get parameters on medications such as beta blockers/ calcium channel blockers. I've often seen hold if SBP

verene, MSN

Specializes in mental health / psychiatic nursing.

Metoprolol usually comes with parameters for the order. (e.g. Do not give if SBP

I personally would use caution in administering a beta blocker to a patient whose BP is 92/52 because of risk of syncope or orthostatic hypotension increasing risk of falls and injury.

amoLucia

Specializes in LTC.

I don't think there's any chance that I'm your pt and you're my nurse, is there????

I've been on metoprolol for ages and my BP is usually in the low 90s/ range. Maybe that's why my BP is controlled BECAUSE I'm taking it and NOT HOLDING it. And it did the trick for my mild tachy.

It's always been my concern that when doses start being held, that's when S&S start to bounce all around. The purpose of medicine is to FIX/CONTROL/ALTER, etc some S&S. The S&S become OK so I guess the medicine is DOING WHAT IT'S SUPPOSED TO.

Unless the dose was on the higher, upper end of dosage range ...

Rose_Queen, BSN, MSN, RN

Has 15 years experience. Specializes in OR, education.

What were the parameters? My facility defaults to hold beta blockers for a systolic less than 90 and a heart rate less than 50 on all patients unless the physician orders another parameter. So for your patient, we would not hold the beta blocker on the basis of the blood pressure. If the patient showed no signs of distress, we'd give it.

Silverdragon102, BSN

Has 32 years experience. Specializes in Medical and general practice now LTC.

Threads merged

!- There should be a protocol in place.

2- It is shockingly ignorant that your charge nurse thinks an antihypertensive won't lower blood pressure.

Just curious- what kind of nursing do you do? This is a very common drug.

Im in medical/surgical, I gave the medication because the patient's BP trended on the low side and the blood pressure med was routinely given with the same low BP to this patient.

However I was just confused when the charge said that metoprolol does not effect BP, only pulse.

I'm also a new graduate nurse and I always look to the charge to tell me the right thing and for help, however this time was just confusing.

What would you guys do if the low BP was low for the patient from baseline, and the charge said that metoprolol does not effect BP and to give it? would you give it? do you always have to do what the charge says?

If youre unsure whether to give a medication or dont have adequately clear parameters, ask the doctor, not the charge nurse.

TriciaJ, RN

Has 39 years experience. Specializes in Psych, Corrections, Med-Surg, Ambulatory.

I'm also a new graduate nurse and I always look to the charge to tell me the right thing and for help, however this time was just confusing.

What would you guys do if the low BP was low for the patient from baseline, and the charge said that metoprolol does not effect BP and to give it? would you give it? do you always have to do what the charge says?

No. You don't have to always do what anyone says. You have to develop and use your own clinical judgement. You were right to question the charge nurse's edict and get some input from your colleagues on AN. Whenever in doubt if someone is telling you the right thing, find additional sources of info to double check.

I've been given more bum steers by people whom I thought should know better. It's the worst when you're new and naturally trust someone's judgement more than your own. Keep on questioning and learning.

Im in medical/surgical, I gave the medication because the patient's BP trended on the low side and the blood pressure med was routinely given with the same low BP to this patient.

However I was just confused when the charge said that metoprolol does not effect BP, only pulse.

There really should be a protocol or parameters on this med. The fact that you don't have one seems to me to be unusual.

Given that there are no parameters, you were right to ask for guidance.

Given how poor the guidance the guidance you received was, you were right to be confused.

It is simply irresponsible for this medication to be ordered without parameters. There is a wide range amongst nurse of opinions, but the opinion that matters most is the one of the person who ordered it.

I guess it would be too much to hope that the doctor had written parameters for holding the medication.

Are you allowed to call the doctor and ask or must you go to the Charge Nurse or to your preceptor?

Can you do a quick look-up in your drug book? Consult a pharmacist?

There really should be a protocol or parameters on this med. The fact that you don't have one seems to me to be unusual.

Given that there are no parameters, you were right to ask for guidance.

Given how poor the guidance the guidance you received was, you were right to be confused.

It is simply irresponsible for this medication to be ordered without parameters. There is a wide range amongst nurse of opinions, but the opinion that matters most is the one of the person who ordered it.

It's probably not as unusual as you think. Unfortunately.

Im in medical/surgical, I gave the medication because the patient's BP trended on the low side and the blood pressure med was routinely given with the same low BP to this patient.

However I was just confused when the charge said that metoprolol does not effect BP, only pulse.

How did the patient tolerate the med? What follow-up did you do? What will you do next time?

I would not have given it. Our protocols, whether there are parameters are not by the MD, caution against SBP

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