guidelines for BP

Specialties Cardiac

Published

Any guidelines for BP before NTG & Morphine administration for CP? Would love input

Specializes in Cardiology.
Pt's BP was about 110/78 but she bottomed out after 1 SLN. Trendelenburg and NS bolus got her BP back up, but afterwards I questioned my judgement for giving it to her at all and wanted to learn from it and prevent this in the future

I wouldn't hesitate to give SLN at 110. (We don't have a written policy with parameters for SLN- just nursing judgement and "if the BP tolerates it.") I would probably not do Trendelenburg, though. I don't believe it is considered best practice anymore. Was the pt symptomatic?

In any case, you can't always prevent the BP dropping- you never know how a pt is going to respond to meds they haven't gotten before. Some people drop like a rock after 1 SLN, some only a little. I stay in close contact with the doc if I have doubts. Get the O2 going, get the EKG done, get meds and a bolus ready, and get the backup you need if things start going wrong. If the pt is having new CP, a doc should be examining them anyway.

I've only been a cardiac nurse for a year, so I'd like to hear what more experienced nurses have to say.

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Specializes in Critical Care.

The best way to avoid hypotension following NTG with CP is to get a 12-lead first. While the majority of MI's affect the left ventricle, if an MI affects the right ventricle then NTG is contraindicated and will typically cause much more severe hypotension than in a LV MI. RV MI's typically need an aggressive increase in preload, while NTG reduces preload.

When NTG is indicated the usual rule is Nursing judgement.

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Specializes in Critical Care.

The best way to avoid hypotension following NTG with CP is to get a 12-lead first. While the majority of MI's affect the left ventricle, if an MI affects the right ventricle then NTG is contraindicated and will typically cause much more severe hypotension than in a LV MI. RV MI's typically need an aggressive increase in preload, while NTG reduces preload.

When NTG is indicated the usual rule is Nursing judgement.

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Specializes in Cardiology.
The best way to avoid hypotension following NTG with CP is to get a 12-lead first. While the majority of MI's affect the left ventricle, if an MI affects the right ventricle then NTG is contraindicated and will typically cause much more severe hypotension than in a LV MI. RV MI's typically need an aggressive increase in preload, while NTG reduces preload.

When NTG is indicated the usual rule is Nursing judgement.

Love the info here. I'm curious- do you typically get an EKG and interpret it before you treat? I'm definitely not experienced enough in reading EKG changes to differentiate anything but STEMI vs NSTEMI at this point. We generally give the first SLN then get the EKG btwn doses, get the MD to the floor, etc.

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Hopefully if your patient is having CP you have or have had some place a call to the MD. In my previous experience on the Cardiac floor we have a Chest Pain Order Set that already had guidelines set in place. You might need to get in touch with your hospitals educator.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I meant what does the BP have to be before I can give NTG and Morphine? In other words, if BP is above....I ca give it and below it I can't
Are you a nurse? a student? This would vary from facility to facility patient to patient....doctor to doctor..

Depending on the patient they may need the medicine to help even though they have a low B/P.......have you looked these meds up?

Have you looked these meds up in a drug book?

What kind of nitro do you mean? IV nitro? sublingual ? In what area of nursing....is the patient monitored?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

duplicate threads merged.

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I just want to thank all of you for sharing on these threads. As a new nurse I've learned so much just by reading these! I realize everything needs to be adjusted to policy protocol, physician preference and orders as well as the patients symptoms, but these real world scenarios really make me think and things just make more sense.

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always always obtain a 12 lead ekg with any CP FIRST. i would not blindly treat that CP without an EKG with active chest pain and post treatment to compare. as another poster said the patient could be having a right sided MI in which case you would not treat with nitro d/t preload reduction which i am oversimplifying. not to mention a whole host of issues and comorbid conditions the cardiac patient may have that would preclude adminstering nitroglycerine simply for cp.

you may also find that SL TNG can promote wild swings in sbp where as IV TNG does not produce such wild swings

also i wouldnt start TNG with a sbp 90 or depending on what is declaring itself, less than 100. where are you going with vasodilators with a SBP starting point of 90? shock?

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The best way to avoid hypotension following NTG with CP is to get a 12-lead first. While the majority of MI's affect the left ventricle, if an MI affects the right ventricle then NTG is contraindicated and will typically cause much more severe hypotension than in a LV MI. RV MI's typically need an aggressive increase in preload, while NTG reduces preload.

When NTG is indicated the usual rule is Nursing judgement.

I'm new to cardiac and had a quick question and am wondering by the EKG, how could you determine if the CP is associated with the left or right ventricle?

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Specializes in RETIRED Cath Lab/Cardiology/Radiology.

Found some sites with info:

r/t MI affecting the RV:

https://www.google.com/search?q=right+sided+MI+ECG+changes&tbm=isch&tbo=u&source=univ&sa=X&ei=QRD3UZO_BcmWigLE_IC4Cw&ved=0CEQQsAQ&biw=1159&bih=563

Right Ventricular Infarction: Specific Requirements of Management - American Family Physician

ECG changes with infarction affecting the LV:

https://www.google.com/search?q=left+ventricular+MI+ECG+changes&tbm=isch&tbo=u&source=univ&sa=X&ei=5hD3UeqeJueIiwLD3YGIAQ&ved=0CFQQsAQ&biw=1159&bih=563

General education re: ECG changes with MI:

http://www.moteclife.co.uk/docs/Education/ECG.pdf

ECG Learning Center - An introduction to clinical electrocardiography

Hope these help. :)

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