HTN question and medication

angelique777 · Dec 18, 2004

Hi folks could use some advise

My moms had recently been hospitilized b/c of chest pain and it was thought to be angina............in the unit she was given catherization and it came back negative ..........we later was told she did not have an MI and that her arteries was fine...........she was sent home.......a week later she was readmitted with severe pain but it turn out to be gallstones ..........the doctor then said that she previously did not have angina but pain related from her gallstones.............

she had been admitted on the first episode of pain with the following meds

Aspirin 81 mg

lasix 40 mg

Norvasc not sure the amount I think it was 20mg

upon discharge she was given metropolol

since I was not with her I was not aware that they dc the other meds

Is their any contraindication to use aspirin with metropolol.

Or any reason not to use lasix????cause not aware contra with lasix

Now I did ask them upon the second admission why was my mother given the beta blocker if they felt she did not have angina the other time nor an MI

they told us that she had pain from the gallstones

no real answer was given and my sister at that time told me in front of the doctor basically not to question them since they where the doctors

now recently spoke to my brother where my mom lives and I asked him has he taken her bld pressure

her blood pressures where as follows

192/115 pulse 70

182/90 pulse70

178/104 pulse 69

she has dependent edema in her ankles

and was complaining of some fatigue

she is also sleepy alot

her sleep cycle is off

she has a pace maker from a previous heart attack about 10yrs ago

I told my brother to take her to the doctor to reevalute her medication

however he has not he says he will monitor her blood pressure over the weekend and let me know

now my mom is on lopressor at 25mg bid and I thought this beta blocker really brings the blood pressure down but I do not see that it is effective since those previous pressure where taken when we were sure of the medication being taken since my brother administered it

now one thing is that my mom does receive delivered food from a service for the elderly and I did ask my brother to check the sodium content and since this company deliver frozen foods the foods are more variable then the other company that brought chicken every day

so that is something we will address to see if they have low sodium foods do not know why they delivered this foods having been given her medical history but that is another issue

the bottom line wanted to ask the nurses their advice since more than likely I will speak to the doctor once my brother is able to take her next week I am trying to convince him to take her

1. question is metropolol the right medication for my mom how can I know

2. did the doctors do the right thing in dc lasix and the aspirin

especially with the dependent edema

3. Was norvasc the inappropriate med for my mother

4. Is there an ideal regimen with some one with my moms history

Note her physician is a general doctor and not a cardiologist I told my brother mom should have a cardiologist or maybe a HTN specialist if there is such a thing

5. Are there really good questions I could ask the doctor to help make sure my mother is getting the proper care

Note: we will try to correct the sodium issue but the medication issue seems important to

6. What other things should I know or ask

thanks hope I can get some help from your expert knowledge

I am a new graduate and trying to do my best

Thanks take care

Angela

Worried about my mom thanks

Pattiecake · Dec 18, 2004

Angela

There is never anything wrong about questioning the doctor's rationale in the treatment provided, however it is the doctor that is examining your mother, not us nurses. Generally the patient is tried on a medication regimen for a period of time and the response to the new meds is assessed at the next scheduled visit. However, if your mother appears to be deteriorating in any way, the next MD visit should be sooner than originally scheduled. It is very difficult to second guess when the patient is not present to be examined. If you are concerned about lack of response to treatment or deterioration, by all means, bring her back to the MD and get a referral to a cardiologist.

Hope this helps

angelique777 · Dec 19, 2004

Angela
There is never anything wrong about questioning the doctor's rationale in the treatment provided, however it is the doctor that is examining your mother, not us nurses. Generally the patient is tried on a medication regimen for a period of time and the response to the new meds is assessed at the next scheduled visit. However, if your mother appears to be deteriorating in any way, the next MD visit should be sooner than originally scheduled. It is very difficult to second guess when the patient is not present to be examined. If you are concerned about lack of response to treatment or deterioration, by all means, bring her back to the MD and get a referral to a cardiologist.
Hope this helps

Maybe if I can refine my question:

a

First thank you for your reply. After rereading my post I can see it really sounds like I am asking what meds to give my mom and what to do with her . Gosh do not really know how to ask the question but I will make one more attempt to try to understand some things.

Thanks though to the reply since based on how I wrote this I would have posted something similar to your.

Yes you are right and their is no question in my mind that yes my mom has to see a doctor and reevaluate her meds I am not unsure of this, never thought it is not ok to ask doctor a question just commented on how the situation presented it self when in the room with the doctor and never got a straight answer as to my mom regimen I guess I am not good at story telling will have to improve on that lol but your right to have told me that since even when I reread it it sounded like I thought is was not ok that is not the case

Just really asking if this was a patient of yours not my mom what would you be thinking

An the above scenario occurred you get a patient 88y/0 with two recent admmission to the hospital and the recent changes with the meds and you obtained the history I gave you above .and got the pressures I got above based on your knowledge of meds what would you know

about metropolol(is is just for someone with a htn problem or is it for some one who is at risk for angina as well) is it just trial and error that meds are given out or is there is a reason for metropolol oppose to the use of norvasc in pressure control etc if the person did not have angina and did not have a heart attack is this the right med etc do we or should we know this in critical care or is this just a doc thing

what as the nurse do you know about the interactions of the lasix and aspirin with this med

would you be thinking about having your doctor reevaluate if he should of d/c the lasix would you be thinking this

would you be think the client should be on the lasix since your client is presenting with edema what would you the critical care nurse be thinking or it contraindicated with metropolol etc

this is the type of question I am asking not really asking what to do with my mom just really trying to understand what as a nurse would know or think if presented with this case and if the patient was your client what would you the nurse being thinking about doing besides the obvious answer go tell the doctor

What labs or test would you think about etc

I am new I am curious to see how much based on what I said above can the critical care nurses tell me that they would do

or is it basically you tell you docs that you patient blood pressure is such and such and you wait and see what they do or do you have an idea on what you would expect

and what else would you know or look for with the pressure up

I can not tell you my mother is deteriorating she states no complaints I see dependent edema and elevated pressure and will again tell my brother to take my mom to have her rechecked and take it from there though I am worried about my mom not at all expecting the room to tell me what to do with her. She will be seeing her doctor. I can see from how I wrote that is mostly what it sounds like cause I wrote it as the problem presented it self and since I am not there I wrote the things that came to my head

Like a detective trying to fill the gaps and trying to figure the rationale behind decisions

It is really scary sometime when you really do not have one person making decision on your health when different events occur and no one communicates to each other about it as if the client is treated based on the sole event and nothing else is looked at and once the person is stable they are discharged and then what ever they prescribed for you last is what you get and a lot of stuff can me missed cause no one is talking to each other.

I seen it happen and often feel the client has to keep really close tabs on everything that is happening to them and even write it down and keep there own files with them

I am just curious to see what actions would an experienced nurse take in this scenario other than just telling the doctor about the pressure

sometime nurses with a lot of experience no more than the resident or PA or new doctor or generalist

I guess I should have asked the question with out stating is was my mom then maybe what I am asking would be clearer

thanks again room for you time and sorry that my initial concern for my mother took away from what I really wanted to know since as a new person your constantly challenging yourself to understand and know what decisions to make when confronted with a situation

I guess I would in this situation do the following with this client supposing the situation was me as a visiting nurse

I Would log the pressure have client keep a log of pressure and pulse

I would make sure client was taking meds

I would talk to the people to have meals changed to low the sodium

I would check chemistry blood work and look at labs check sodium

I check labs to see and evidence of dehydration

(question if dehydrated does pressure go up?)

I would ask doctor if patient did not have angina and did not have heart attack what is the rationale behind using this beta blocker

I would let doctor know the client has dependent edema and that doses of lasix and aspirin where d/c and was he aware of this

(is there contraindiction with aspirin and lasix with lopressor????)

I would tell the physician about the pressures and ask what his plan was for the client based on my assessment of edema elevated pressure fatigue

(question what does the pressure have to be to warrant a visit to the emergency room)what is the lowest high to warrant a visit

I would have the client elevate legs to help with the edema

would aspirin help at all if client blood pressure high and edema present willl taking a baby aspirin help as a precaution in this case at all while you wait to see what the doctor does with your meds (this in the case that your are the client and can self administered something would you or would you wait)

Gosh hope I am making sense and someone gets the drift of what I am asking since I use to many words to say something simple

I hope I did a better job at asking and can get some replies thanks think you guys are great love reading all post in various rooms and thanks again to you who respond so nicely to me see ya

Angela

Pattiecake · Dec 19, 2004

Angela

There is no way I can answer all the questions you ask. If this was my Home Health patient and she was on the meds as stated by you, I would assess the following.

Edema: how are the lungs? any rales? if so, notify the MD. if not, recommend a lo Na diet and elevate FOB and LE's while pt in the chair. Encourage ambulation. How are the electrolytes and renal function. was lasix D/C due to labs. It is not necessary to treat dependent edema with diuretics. How about some TED stockings?

BP: Ask the MD what parameters of BP he/she wishes to be made aware of. I would certainly report anything above 160/100, regardless of what the given parameters are.

How does the patient look, and how does she say she feels?

Fatigue/tiredness: One of the side effects of metoprolol is tiredness. Also please remember the patient's age and amount of edema. And maybe she isn't very comfortable in bed and is not sleeping well at night, so naps a lot during the day. Maybe she is a bit depressed due to her physcal limitations and that is why she is sleeping a lot. Sometimes the answers are very simple.

I would never recommend what meds a patient should or should not be taking as that would be practicing medicine, and I am not licensed to do so. By all means ask the MD the rationale of the treatment plan. Ask the MD why certain meds have been D/C and others continued. And ask for that referral to the cardiologist if you are at all in doubt about this MD's ability to meet all your mother's complicated needs.

angelique777 · Dec 19, 2004

Angela
There is no way I can answer all the questions you ask. If this was my Home Health patient and she was on the meds as stated by you, I would assess the following.
Edema: how are the lungs? any rales? if so, notify the MD. if not, recommend a lo Na diet and elevate FOB and LE's while pt in the chair. Encourage ambulation. How are the electrolytes and renal function. was lasix D/C due to labs. It is not necessary to treat dependent edema with diuretics. How about some TED stockings?
BP: Ask the MD what parameters of BP he/she wishes to be made aware of. I would certainly report anything above 160/100, regardless of what the given parameters are.
How does the patient look, and how does she say she feels?
Fatigue/tiredness: One of the side effects of metoprolol is tiredness. Also please remember the patient's age and amount of edema. And maybe she isn't very comfortable in bed and is not sleeping well at night, so naps a lot during the day. Maybe she is a bit depressed due to her physcal limitations and that is why she is sleeping a lot. Sometimes the answers are very simple.
I would never recommend what meds a patient should or should not be taking as that would be practicing medicine, and I am not licensed to do so. By all means ask the MD the rationale of the treatment plan. Ask the MD why certain meds have been D/C and others continued. And ask for that referral to the cardiologist if you are at all in doubt about this MD's ability to meet all your mother's complicated needs.

Patty cake you have most certainly done what I wanted.... kinda gave me a view of what you would do

you reminded me that you do not always think diuretics when you have dependent edema that teds could be of help

everything you said helps me a lot your have been great. that was kinda the answer I was looking at wanted to see what someone would do in that situation and you did thanks so much