Hold Medication

This was definitely one thing I didn't like about nursing school. You could give 50 nurses this same scenario and they'd probably all have different answers/rationales for what they would do. Honestly...this scenario is far too vague, there's no black and white answer for this. In the "real world" you would take several other things into consideration, like, is the pt symptomatic with this BP? Is the pt here for CHF exacerbation and fluid overload? What is the HR? Are they sinus or in an atrial rhythm? Is cardizem prescribed for HTN or for HR control?

What I would do...

If the cardizem is prescribed because of an arrythmia/tachycardia I would give it. You will probably have low blood pressure with a very fast HR, so in that case cardizem would correct the problem instead of worsen it. If it's strictly prescribed for blood pressure, I would hold it. But...you kind of get a clue with the lanoxin, so sounds like this a patient who needs HR control....maybe this is what your instructor was wanting you to pick up on?

I would still give the lasix if they are fluid overloaded. Sometimes CHF-ers "live" in the 80's and it's "ok" for for them because their LV function is so poor. You would not hold diurectics for this pt. But, if they are symptomatic with the low blood pressure, I would hold it. This is possibly a pt that is now too dry and needs fluid, so for this pt, giving lasix and the potential of lowering the pressure further would be a very bad thing.

Prinivil...definitely would hold that symptomatic or not.

Demerol....would hold if ordered in IV form for sure.

Hope that helps!!

Your right, I neglected to include more of the important information.. but you answered my question.. The benefits of correcting the problem whether is be atrial fibrillation, angina or any other reason would outweigh the risk of having lower BP.

Thank you