Blood pressure meds..without parameters???

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I have this patient that the Doctor Discontinued the Blood pressure Parameters. We have been holding her Blood pressure medication because of her low blood pressure. The parameters were : Hold if SBP

The Doctor discontinued the Parameters. The Doctor is aware of the Low Blood pressure. The patient Code Status is DNR.

I haven't called the MD. I didn't carry the order. It was the Nurse who worked at that time. I talked one of the Supervisor about this. And they say that it is Doctor's Order...and we should follow it. My license is covered since it is ordered.

The problem here is that.....Can we hold the BP meds if it's SBP

Specializes in Peds, ER/Trauma.

If the doctor didn't leave any parameters, call him/her before giving the med, and say "Mr. Smith's BP is 95/42. Would you like me to hold the Lopressor?" If the doc says to give it anyways, make sure you chart "Dr. Brown called and notified of BP: 95/42. Dr. Brown stated to give Lopressor as ordered." This way you're covering your butt if the pressure bottoms out. Just make sure you have IV access, fluids ready to go, and can quickly put the pt. in trendelenberg should the pressure bottom out......

Kymmi

340 Posts

Specializes in CVICU-ICU. Has 20 years experience.

I think DNR status should not play a role in this...in other words dont let someone say well she's a DNR so what does it matter.....I hate when people say that and trust me I've heard it more than once over the years...anyway thats a whole other issue.

As far as what you are asking this is what I would do.....alot of our cardiac surgeons and cardiologist will write to hold if SBP

Long story short....do what YOU think is best for the patient and dont do something that you feel uncomfortable doing just because the MD or the supervisior said so.

I've been a nurse a long time and I can remember when I was first starting out having the mindset that I shouldnt question....but it didnt take long for me to begin questioning and refusing when I realized that I have a brain just as much as that MD writing the order.

ari3sdog

100 Posts

I think DNR status should not play a role in this...in other words dont let someone say well she's a DNR so what does it matter.....I hate when people say that and trust me I've heard it more than once over the years...anyway thats a whole other issue.

As far as what you are asking this is what I would do.....alot of our cardiac surgeons and cardiologist will write to hold if SBP

Long story short....do what YOU think is best for the patient and dont do something that you feel uncomfortable doing just because the MD or the supervisior said so.

I've been a nurse a long time and I can remember when I was first starting out having the mindset that I shouldnt question....but it didnt take long for me to begin questioning and refusing when I realized that I have a brain just as much as that MD writing the order.

Thanks a bucnh =D

TheCommuter, BSN, RN

226 Articles; 27,608 Posts

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 17 years experience.

Call the doctor to clarify this order. If the doctor still orders you guys to administer the antihypertensive medication with absolutely no parameters, I'd document the conversation with the MD in 2 places. I'd first write a telephone order that states, "Lopressor 25mg po BID with no BP/pulse parameters per MD order." I'd also document direct quotes from conversation with the MD in the nurses notes meticulously. Cover your behind!

suzanne4, RN

26,410 Posts

I am moving this thread to the General Nursing Forum since it is not specific to CA, but to nursing in general.

suzanne4, RN

26,410 Posts

Just to add this in:

What medication are you holding with those parameters? Example: metoprolol is given more for heart issues than for BP so is normally given even with the blood pressure in the 90s. This is something that needs to be clarified with the physician.

zuzi

502 Posts

Specializes in trauma, ortho, burns, plastic surgery.
Call the doctor to clarify this order. If the doctor still orders you guys to administer the antihypertensive medication with absolutely no parameters, I'd document the conversation with the MD in 2 places. I'd first write a telephone order that states, "Lopressor 25mg po BID with no BP/pulse parameters per MD order." I'd also document direct quotes from conversation with the MD in the nurses notes meticulously. Cover your behind!

Is the the best explanation that I ever read it, thank you for your logical mind! That is! :w00t::up:

pagandeva2000, LPN

7,984 Posts

Specializes in Community Health, Med-Surg, Home Health.
Call the doctor to clarify this order. If the doctor still orders you guys to administer the antihypertensive medication with absolutely no parameters, I'd document the conversation with the MD in 2 places. I'd first write a telephone order that states, "Lopressor 25mg po BID with no BP/pulse parameters per MD order." I'd also document direct quotes from conversation with the MD in the nurses notes meticulously. Cover your behind!

After clarifying with the MD and documenting this, would you still give it? I worry about this alot. I have not faced this situation just yet, but this is one of the many things that happen in med-surg, and I will be working there per diem really soon.

Thus far, I would call the doctor and document, then, make the decision based on past readings and see if it was already administered by other nurses with no problems. Thanks!:up:

allnurses Guide

llg, PhD, RN

13,469 Posts

Specializes in Nursing Professional Development. Has 46 years experience.
After clarifying with the MD and documenting this, would you still give it? I worry about this alot. I have not faced this situation just yet, but this is one of the many things that happen in med-surg, and I will be working there per diem really soon.

Thus far, I would call the doctor and document, then, make the decision based on past readings and see if it was already administered by other nurses with no problems. Thanks!:up:

Why not review the patient's history and his/her previous response to the medication BEFORE calling the phyisician? That would give you the information to include in your consultation with the doc.

Maybe the patient tolerates the med in that situation very well.

I'm not a med-surg nurse and no expert on BP meds -- but I do take 3 BP pills per day myself (2 different meds). I take them with no parameters given and frequently have BP's in the 96/58 range just before I take my one pill for dinner. (Then I take another med 4 hours later just before bed.) My doc knows this and is fine with it as long as I am tolerating it. My BP goes up significantly as I sleep, so, I need to "load up" as I go to bed. During the day when I am active, my BP drops because of all those meds on board, but I seem to be tolerating it so far. Maybe the patient is like me.

I'd find out what the patient's usual pattern is before talking with the doc and before jumping to conclusions based on 1 or 2 numbers.

not now, RN

495 Posts

Specializes in LTC, med-surg, critial care. Has 3 years experience.

What is your hospital policy on med administration? I was told by one nurse that I could not hold a med at any time unless I had an order (I had held a BP with no parameters on a patient with a systolic in the 90's, I also held a routine Ativan on a geriatric post-op patient who's RR was slow). The oncoming nurse that told me this was giving me a hard time about it like I had committed a felony or something.

I read the hospital policy and it stated that a nurse can hold a medication with his/her discretion then the MD must be notified at an appropriate time. I would hold it and ask what the deal is (in more professional words of course ;) ).

sharlynn

318 Posts

Specializes in ICU, CCU,Wound Care,LTC, Hospice, MDS. Has 43 years experience.
Just to add this in:

What medication are you holding with those parameters? Example: metoprolol is given more for heart issues than for BP so is normally given even with the blood pressure in the 90s. This is something that needs to be clarified with the physician.

I take Hyzaar for hypertension and metoprolol to lower my pulse ( my doc claimed fewer side effects than Dig). My mother's doc has told her never to hold Metoprolol because of rebound B/P - something never mentioned by my doc.

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