Criteria for Giving IV BP Meds?

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Specializes in Pediatric/Adolescent, Med-Surg.

So last night at work I was getting report on a pt from the ER and noticed their blood pressure was 200/100 when triaged. 6 hrs later when I was getting report on the floor the BP was 210/110 When I asked the nurse what she had given the pt to treat the BP her excuse was nothing, as due to the pt's vomiting the pt couldn't keep any PO meds down. I questioned why Hydralizine IV hadn't been given, the nurse seemed to not understand why you would give it if the systolic is less than 220. Pt ended up getting nothing for BP in the ER. The nurse taking care of the pt is a travel nurse new to my facility, so I'm curious, what is the criteria at other facilities are for giving IV BP meds?

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Specializes in Cardiovascular, ER.

You know? That is a good question, honestly. Coming from cardiac floors, I was used to treating generally anything over 160 sbp (unless suspect ischemic cva). In the ER, it is like pulling teeth to get a doc to order an IVP BP med. I'm not kidding. They don't really care in my ER unless it is 220 or higher. Now a fast HR they treat, or a low BP.

Curious to hear the other answers.

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I don't work in the ED, but the criteria for my unit is to treat with IVP or IVPB if systolic is over 160.

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Specializes in Emergency & Trauma/Adult ICU.

I can't say we have a hard & fast policy.

That BP in triage ... in a patient actively vomiting ... would not necessarily worry me.

That it remained elevated for 6 hours is another story, although your post seemed to indicate that the nausea/vomiting had not resolved and therefore could probably still account for the elevation. What was the patient's admitting dx?

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Specializes in Emergency & Trauma/Adult ICU.
I don't work in the ED, but the criteria for my unit is to treat with IVP or IVPB if systolic is over 160.

In an ED setting, that criterion would mean treating probably 60% of patient who walk through the door, and in half of those we would be treating a symptom unrelated to their chief complaint.

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Specializes in Pediatric/Adolescent, Med-Surg.
I can't say we have a hard & fast policy.

That BP in triage ... in a patient actively vomiting ... would not necessarily worry me.

That it remained elevated for 6 hours is another story, although your post seemed to indicate that the nausea/vomiting had not resolved and therefore could probably still account for the elevation. What was the patient's admitting dx?

New onset/relapsed renal failure. BUN/Creat 18/130

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Specializes in PCU/Hospice/Oncology.

Um.. Really? Why on EARTH wouldnt that be treated? Its on them if they stroke out. Bring that sucker down nice and slow, Clonidine/Labetelol/Vasotec... I work on a PCU, Persistent High BP is something we see every day. Start with a medium IVBP med to slowly bring that sucker down if they cant take PO. If it still isnt budging bring out the heavy guns. Ive seen some pretty unintelligent moves down in our ER.. Sending pt's up with FLUIDS going around 100/hr with CHF and BPs in the upper 180s...

Its our job as the nurse to make sure the Dr isnt killing the patient :p GET THAT ORDER!

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Specializes in Pediatric/Adolescent, Med-Surg.
Um.. Really? Why on EARTH wouldnt that be treated? Its on them if they stroke out. Bring that sucker down nice and slow, Clonidine/Labetelol/Vasotec... I work on a PCU, Persistent High BP is something we see every day. Start with a medium IVBP med to slowly bring that sucker down if they cant take PO. If it still isnt budging bring out the heavy guns. Ive seen some pretty unintelligent moves down in our ER.. Sending pt's up with FLUIDS going around 100/hr with CHF and BPs in the upper 180s...

Its our job as the nurse to make sure the Dr isnt killing the patient :p GET THAT ORDER!

The ER docs had ordered PO Clonidine but the pt could not keep it down with the vomiting.

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Specializes in Emergency & Trauma/Adult ICU.

Having recently dealt with a nasty stomach bug, I can say this ...

Next time you're vomiting - see if you feel your heart pounding. What do you think your BP and HR are?

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Specializes in PCU/Hospice/Oncology.

So call and get the order changed. Nurses are problem solvers as one of our many hats. True we dont know the entire situation but I see lazy nursing every day on my unit. As a patient advocate sometimes we need to "suggest" to the Dr what might be best for the situation.

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Specializes in Pediatric/Adolescent, Med-Surg.
Having recently dealt with a nasty stomach bug, I can say this ...

Next time you're vomiting - see if you feel your heart pounding. What do you think you're BP and HR are?

Yes I get that. But I think that more of it was from the pt's kidney's failing than it was from vomiting or other secondary issues.

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Specializes in Emergency & Trauma/Adult ICU.
Yes I get that. But I think that more of it was from the pt's kidney's failing than it was from vomiting or other secondary issues.

I agree renal failure = BP issues. But with continued vomiting, I'm not convinced that you wouldn't have been treating an artificially elevated number. My plan would be to get the vomiting under control & get the patient settled ... obtain some more realistic VS, then treat accordingly.

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