Holding Antihypertiensives

[jamiejohnson2007]

I have a question regarding holding antihypertensive medications. I am currently an LPN, and will be completing my ASN program in May, so will soon be an RN. Today, a co-worker and I had a situation where we decided to work together on our patients, just to make things easier. We work at a rural, critical access hospital. Med-surg, wide variety of patients. Anyway, the patient we were working with has a PEG tube and is NPO, s/p CVA, MI. He is scheduled to receive 6.25mg Coreg (Carvedilol) BID. We assessed BP reading of 83/46 and P-54. (The coworker I was with is an RN.) She saw the pressure and said she was going to hold the scheduled Coreg dose. I agreed with her, as we have both learned in our schooling when BP is

[LPN_FTW]

I think you used good judgement with holding the medication. I'd have held the dose and contacted the doctor for a follow-up while continuing to monitor her BP t/o the shift as needed. Also, to reiterate other posters, I'd have definitely used a BP cuff and auscultated, not using the damn machines. I hate those things lol

[Sun0408, ASN, RN]

It's not only legal, but expected for Nurses to hold a med based on their judgement. You do need to inform the MD when you hold a med, but if the MD says "give it anyway" you are still expected to follow your judgement, not the order, the MD can come in and give it himself if no agreement can be reached.

That is what I am saying, the MD needs to be aware.. Refusing to give meds after the MD is aware is a totally different story..

[vampiregirl, BSN, RN]

Just a thought to add to this discussion... If I call a doc r/t administering/holding an antihypertensive/ betablocker, I always request parameters to add the the order as a clarification regardless of whether the provider wants the med administered or held.

[KelRN215, BSN, RN]

It's not only legal, but expected for Nurses to hold a med based on their judgement. You do need to inform the MD when you hold a med, but if the MD says "give it anyway" you are still expected to follow your judgement, not the order, the MD can come in and give it himself if no agreement can be reached.

I agree. It behooves a nurse to hold a medication - with or without MD order - if, per the nurse's judgment, the medication/order is inappropriate. I recall an MD (a Fellow) ordering a 2L fluid bolus on a 2 yr old who weighed somewhere between 10-15 kg. Fluid boluses in children are typically 10-20 mL/kg. The nurse questioned it and the MD refused to change the order. Who would have been at fault if she gave it- knowing it was inappropriate- just because it was ordered? It wouldn't protect the nurse- at all- for her to say "the MD told me to do it."

[dudette10, MSN, RN]

I agree with those who say you need to know why a med is given, the patient's history with the med, and to question an order when, after your research, something doesn't look right. I was dumbfounded one day when I saw a MAR with a very high dose of Coumadin daily. I thought, "This can't be right!" However, after reading the notes, and, more importantly, talking to the patient about his usual dose, I gave it without worry. In my experience, meds are not always as simple as "hold/give this when a value is this."

[chevyv, BSN, RN]

I would hold the med and call the doc. I would question the doc if he/she would tell me to give it anyway. I don't question to be difficult, I question to learn. I usually don't have a problem with asking why if the doc knows I want to actually learn. It's good to question. I didn't go to med school and I give so many medications that are often used for something other than what they were made for.

I too would request parameters :)

[ParisAntonel]

I hold BP meds all the time when I don't feel safe , meaning SBP lower than 110 and pt has multiple BP meds. However, you cannot hold meds without MD's order, so I always call MD within an hour. I ask for parameters , and make them aware of VS and BP meds that were held. If I know the MD and the BP is not very low and pt is not having s/s of hypotension I wait for MD to make rounds. In your case, with that low BP and if pt is symptomatic , I would definitely call MD.