Blood pressure meds..without parameters???

[ari3sdog]

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

[Virgo_RN, BSN, RN]

Here's the deal....The pts BP is 'low' becaue the meds are WORKING. That's the point! And, I don't find an SBP of 95 to be all that shocking.

Exactly. Depending upon the patient's diagnosis, you could actually be doing harm by holding an a vasoactive med simply for an SBP in the 90s. I've had patients where the cardiologist WANTED their SBP to be in the 80s because the patient's condition warranted it. In situations like that, you are not being a very good patient advocate if you are second guessing the cardiologist, and I'd be steamed if I were the cardiologist and found out that nurses were holding the med.

[ElliShay]

Exactly. Depending upon the patient's diagnosis, you could actually be doing harm by holding an a vasoactive med simply for an SBP in the 90s. I've had patients where the cardiologist WANTED their SBP to be in the 80s because the patient's condition warranted it. In situations like that, you are not being a very good patient advocate if you are second guessing the cardiologist, and I'd be steamed if I were the cardiologist and found out that nurses were holding the med.

Well-said. Post-CABG patients are a good example-- holding BP meds (resulting in increased BP) can damage the graft site.

[morte, LPN, LVN]

Well-said. Post-CABG patients are a good example-- holding BP meds (resulting in increased BP) can damage the graft site.

heart failure/cardiomyopathy also.....i remember a patient in LTAC in his 50's iddm,renal and cardiac....parameters were sbp in the 80's.....with supplemental meds if over something like 100!

[cosmicsun]

Doctors should put parameters on ALL BP meds to take out the guess work. What about new grads??? Which the hospitals have lots of. Some doctors do get aggravated being called for BP meds, when it would have been just as easy to put parameters. Also, don't just put parameters on one BP med. This means you WILL receive a call on the other. We don't know if you forgot the other one or if you give it no matter what.

Thank you doctors.

[dishes, BSN, RN]

Great response kymmi, I too would ask the doctor the reason for giving a medication that seemed contraindicated.

regards

dishes