Dilaudid, IV push, Blood Pressure.

[andrewprincesspeach]

I was caring for an elderly patient, her blood pressure was 77/55. I was sitting with the patient and she seemed to be in pain (Pt stated and pt was in distress). I told the nurse that she was in pain, but her blood pressure was too low. And the only drug on her "MAR" was Dilaudid. I was wondering if the nurse should hold the drug? or should she give it, regardless?

[turnforthenurse, MSN, NP]

When deciding to give or hold a med, do a little digging. Look back on the old MAR to see if they gave her any Dilaudid, and how much. Look at her vital signs history and look at her blood pressure. If they have been giving it, I would probably go with a lower dose (generally they would say "Dilaudid/hydromorphone 1-2mg q4-6h prn for pain...so I would give the 1mg). If the nurse (or you) decides to hold it, maybe try other pain-relief measures.

[Music in My Heart]

Any one BP is not as meaningful as the general trend as well as the pt's clinical presentation.

Rather than push it, I'd probably dilute it in 5-10 cc of NS and run it as a secondary over 10-15 mins and keep an eye on the pt as it's going.