BP Meds

[bushy]

I have a question for you all. We have several patients who are on very high doses of BP meds (i.e. Lopressor 100/Capoten 100mgm) and the Attending and his PA's have written orders to give it unless their BP's drop to 90/50!!! The patient on the Lopressor we have to give until his Systolic drops to 70 or below!!!!! Give it or else....no questions asked!!! If you do not give it it will be a med error and you will be written up! We can no longer use Nursing judgement. I was taught in school that you do NOT give a BP med if the BP drops to or below 120/60! Has this changed?

We are told that these meds are not so much for BP but to increase his cardiac output and that's fine but 90/50????? This goes against everything I was taught. We are being told NOT to question them because they have a license and know more than we do......and what do I have a punch ticket from Subway??? If it were to ever go to court I would be one liable because I gave the medication.

Thanks!!!

[BarbPick]

The parameters of blood pressure have changed and doctors and NPs have changed their tune on medication.

I used to ask a question when I taught diabetes education of "what is a crisis Blood Pressure in a diabetic." The answer used to be 141/91. Now it is more like 125/ 86. Ace inhibitors are not just given to lower blood pressure, they are given to non hypertensive diabetics just in case, to save their eyes from blindness in the microvascular areas as well as the microvascularity of the kidneys to prevent renal failure. Nursing Judgement has nothing to do with why they want it given. Nursing Education does.

[jaimealmostRN]

When in doubt, call the floor nurse manager or nursing supervisor if he or she usually handles these things. In school we have learned that you do not give these meds if the BP is/goes below 100/50. I understand the issue of increasing cardiac output, etc, but you don't want to give a med you are not comfortable giving/don't understand why your giving it and then end up in court explaining your actions if something really really bad happens!

[Teacher Sue]

Some physicians are more concerned with a mean blood pressure than the systolic. An MAP of 60 or greater is usually condidered adequate for tissue perfusion. I know one physician who feels a mean of 50 is acceptable as long as the patient is asymptomatic. A patient with a BP of 90/50 has a mean of 63 (50x2) + 90=190.

190/3=63.

[llg, PhD, RN]

It seems to me that the real question/issue here is: "What is the politically proper way for the nursing staff to get this issue resolved?" The people here on this bulletin board can only speculate as to the phyician's reasoning.

First of all, identify the appropriate person within the nursing department to address the issue with the physician. It might be a Clinical Nurse Specialist, Staff Development Instructor, Manager, etc. That person could go to the physician and say something like, "This really goes against what most of the staff has been previously taught. If we are going to change our practice, we are going to need some inservice on this topic. Would you, Dr. ___ be willing to participate in this inservice? ... or can you share your references with me so that I can use them to prepare the inservice? etc."

Standing around questioning a change like this rarely improves these types of situations. Addressing it politely and professionally through the proper channels is your best bet. Expressing a desire to learn more about it opens up a potentially productive dialog with that physician. Your questions and concerns can be raised as part of the inservice discussion.

Good luck,

llg

[Tweety, BSN, RN]

As was mentioned the thoughts on hypertension have changed. Prehypertension is now BPs over 120, with the goal to stay below that.

It's scarey giving high dose antihypertensives, but they are on them for a reason. So many times I've come on to a pt who had their BPs meds held for say 110/50, to find them at 180/110 for my assessment.

Thanks Teacher Sue for the reminder about the MAP.

[stella123 rn]

This happens often. They still may need to be given. The doctor always says it is a risk vs. benefit thing. I get all my facts and call the doctor. I let them make the call. I always write it as an order and may even write a note about it. Even if there are preset parameters and there is something else going on I call. I have had orders to give BP meds at 70s/40s and the doctor ended up being right. There BP stayed the same. I was nervous though.

[bushy]

Thank you all for your imput on our BP problem.

I especially liked the inservice idea from llg....I understand the needs of patients and giving certain meds but we would like to the reasons why we are doing it.

Thanks to you all and have a great day!

Bushy

[Tweety, BSN, RN]

Originally posted by bushy

Thank you all for your imput on our BP problem.

I especially liked the inservice idea from llg....I understand the needs of patients and giving certain meds but we would like to the reasons why we are doing it.

Thanks to you all and have a great day!

Bushy

It's very important to know the reasonings behind every med you give. So kudos to you for seeking better understanding. After all it is the one who gives the med to the patient that is ultimately responsible regardless of what the doctor orders.