How soon to give PRN Clonidine after routine BP meds?

[everybodyluvsanurse]

I had a resident today who is a brittle diabetic and receiving dialysis. During the 12noon med pass, done by the med aide, the resident's b/p was checked prior to getting b/p meds. The b/p was 200/80 (not reported to me). Then the resident was given his routine b/p meds by the med aide. I found out his b/p was elevated when the family showed up, checked the b/p and became irrate with me. I was finally able to assess the resident at 1230p. I did a manual blood pressure, it was 176/80. How long should I wait to see if routine b/p meds are gonna take effect before I give prn clonidine??? The family was very angry and wanted me to give prn clonidine right then. According to the MAR this resident's b/p runs in the 200's daily, and usually resolves with routine b/p meds (If the documentation on the MAR is truthful and accurate). I only seen 1 incident on the MAR where prn clonidine was given. **sigh** I don't want the resident to stroke out....b/p seemed to be coming down....I didn't want to give him clonidine and have the pressure bottom out either. Any advice would be greatly appreciated.

[speedyG]

What's the parameter on the clonidine?Since her bp went down after the routine med i'd reassure the family you'd recheck the bp again later to monitor. I've had systolic higher than 200 only to drop a few minutes later.

[CoffeeRTC, BSN, RN]

I had a resident today who is a brittle diabetic and receiving dialysis. During the 12noon med pass, done by the med aide, the resident's b/p was checked prior to getting b/p meds. The b/p was 200/80 (not reported to me). Then the resident was given his routine b/p meds by the med aide. I found out his b/p was elevated when the family showed up, checked the b/p and became irrate with me. I was finally able to assess the resident at 1230p. I did a manual blood pressure, it was 176/80. How long should I wait to see if routine b/p meds are gonna take effect before I give prn clonidine??? The family was very angry and wanted me to give prn clonidine right then. According to the MAR this resident's b/p runs in the 200's daily, and usually resolves with routine b/p meds (If the documentation on the MAR is truthful and accurate). I only seen 1 incident on the MAR where prn clonidine was given. **sigh** I don't want the resident to stroke out....b/p seemed to be coming down....I didn't want to give him clonidine and have the pressure bottom out either. Any advice would be greatly appreciated.

Always assess the pts for yourself, so taking the res bp was good. I would ask the doc for parameters on when to give the prn med. You can also look up the meds to find out when they peak and begin to work and/ or call the pharm. I would probably wait at least an hr before rechecking. Wonder if the family causing such a stir is causing the BP to elevate too?

[turnforthenurse, MSN, NP]

What kind of BP meds did this patient receive? You mentioned the patient being on dialysis...keep in mind that patients with renal problems are not used to "normal" BP's - they may not be able to tolerate a BP of 118/78. I would also see what the parameters for clonidine were, if any were given. Typically our parameters are for a BP >165/>100 or >110, but it is to the doctor's discretion. Some do not want clonidine given unless the SBP is >180. Clonidine is also more effective if given TID as opposed to PRN because of rebound hypertension.

I also would have rechecked the BP in an hour or so before giving the PRN clonidine.

[everybodyluvsanurse]

Thank you!!! All your comments were VERY helpful for future reference. I did not give the prn clonidine. In a simular situation days later the patient was given a prn clonidine too soon by someone else and ended up in the ER.

[Mahogany Queen]

I know this is an old thread, but I had the same issue today. I had a patient with high bp before getting scheduled bp med. I decided to administer bp meds first, then recheck bp's in an hour. An hour later, bp lower, still elevated, but does not meet parameters for PRN bp meds (usually clonidine 0.1 mg for sbp>180 or dbp >105 in my facility). Note left on chart to MD explaining occurrence. Anyway, the nurse I gave report to indicated that she would gave given the PRN clonidine with the scheduled bp med and that would have been therapeutic. Since this nurse has much more experience than I, I am now rethinking my choice. What do you think, please?