holding lasix d/t BP reading

linearthinker, DNP, RN · Sep 11, 2011

IME, there are usually parameters, usually hold for MAP

Often times there was a very good reason to do something I felt uncomfortable doing, and it was a learning opportunity for me.

Elvish, BSN, DNP, RN, NP · Sep 11, 2011

Is the Lasix IV or PO?

Heart failure acute or chronic?

If it was the patient's regular home po dose I might go ahead and give it.

Either way, like you said, the answer depends on so much. My floor doesn't give it much, and it's been a while since I worked med/surg, so take what I say w/ a grain of salt. :)

xtxrn, ASN, RN · Sep 11, 2011

I'd call for parameters- get everyone on the same page :)

mandrews · Sep 11, 2011

At my hospital it is based on parameters outlined in the chart or MAR. If there are no parameters then someone would have to call the doctor. Now if a different doc is making rounds it may be based on a different opinion. Sometimes there may be a change in diagnosis... suppose the pt had a stroke while admitted. You would think it was due to their bloodpressure so you want to treat the BP.... in actual fact in most cases we keep the pressure higher to increase bloodflow to the brain.

Another thing that comes to mind is if the patient starts getting really tachy then the doc may think they are getting too dry and hold the dose.

The best thing to do is ask questions of the RN about the held dose. Its the best way to learn.

RNdiva505 · Sep 11, 2011

Yup. It all depends. Is there edema involved, CHF, etc....The answer is not very clear cut just depends on each individual situation!

BriWisco · Sep 11, 2011

I would look for other values besides the BP... electrolytes, urine output, weight (trend), lung sounds... always look at the bigger picture! :)

merlee · Sep 12, 2011

Although I occassionally take my BP at home, I nearly always take my Lasix. I am bad sometimes - if I am concerned about where there may be a bathroom or if I will even be near one, I may defer my Lasix 'til later.

I try to keep my feet and legs elevated as much as possible.

mama_d, BSN, RN · Sep 12, 2011

Some chronic CHFers live with lower pressures just due to all the meds they have to be on. Was it a sudden change in BP or within pt's norm? And how low was low? Are we talking SBPs in the 100's or in the 80's? What was the MAP? What other meds were they on...were they scheduled all at once with several meds that affect BP, could the dose have been held for a while and then given slighty later? Chronic or acute CHF? Lasix po or IV? What's the EF? Were they symptomatic, or were they able to tolerate their normal activity level at the lower pressure?

We have some FF whose hearts are just shot...EFs in the 5-25% range with AICDs and have to be on their maintenance meds, docs are happy if their SBP stays over 80, with dips into the 70's at times being perfectly acceptable.

CHF can really suck to try and manage...like now we've got one, fairly new diagnosis who didn't understand that she had to be very strict about following hwr regimen at home. Came in with crappy CXR, BNP over 3000, cath showed EF of 15%, we tried to aggressively diurese her (she's young and only other PMH was htn). Now we've put her into ARF due to the meds, kidney function is continuing to decline despite d/c'ing meds, and she's filling back up again...her abd is so tight I'm surprised she doesn't spring a leak every time I give her heparin. BPs are now running 70-90's systolic, MAPs are consistently hitting below 60, and it seems like all we're doing is watching her get worse. Frustrating to say the least. When the docs can't even figure out what to do next, how are we supposed to be able to do so?

MunoRN, RN · Sep 12, 2011

I wouldn't hold it without asking, although whether or not to give it still up to you in the end. Some things to consider; CHF patients should have a low BP, an SBP in the 80's is just right for a patient with an EF of 10-15%, holding lasix on such a patient because of an SBP of 85 would be bad decision making. Lasix doesn't directly lower BP, it lowers BP through it's effect on fluid volume. So if the dose is just going to maintain a consistent fluid volume status, then you won't see any change in BP. If you're considered that the patient is dry and therefore there might be some justification to discuss holding it with the MD, you can look at the patient, BNP/creatinine ratio, or even better a CVP, otherwise just a low BP isn't really enough to justify holding it.

dudette10, MSN, RN · Sep 12, 2011

Thanks to all for replying. You've given me a lot to think about. Right now, my critical thinking seems so slow and labored; I hope it gets easier with experience. :)

Jenni811, RN · Sep 12, 2011

nurses should never ever have to make that decision.

If i ever question holding a medication, i'll page the doctor. I don't care what the doctor says. Because if i give metoprolol for a BP 90/50, then your going to get all over my case about "why i didn't page you" or "Why i didn't hold the medication"

...so whatever, i could care less if they get mad at me for asking.

And if i ever question it, and if it ever comes to me paging the doctor i ALWAYS ask at the end "Do you mind putting some parameters in so we can prevent his next time?"

It takes a SECOND to put the parameters in, but now you have to make this a 20 minute process to figure out if you want this medication given or not.