HTN urgency with IV Beta Blockers

HappyNurse2005, RN · Apr 30, 2006

Well, if a pt came into the ED with a BP of 220 systolic, they'd probably be admitted to a monitored bed, so they'd have a monitor.

If this were to happen on a med surg floor? I don't know. I would think so, but i dont have a good reason why

AndyB · Apr 30, 2006

Gentleman in his 60's with a 185/105 BP. Came in due to upper leg pain after lifting heavy objects onto the back of a pick-up truck.

Where I was at before, one of the docs used to write prn orders q6 for Lopressor 5mg IV for SBP>160. That was in a med/surg but I'm in the E/R now and I'm trying to catch the drift of things.

ljds · Apr 30, 2006

Our protocol is tele monitoring with such IV meds.

zacarias, ASN, RN · May 1, 2006

Tele monitoring is a good idea, but I can see IV beta-blockers being given in a med/surg area without tele and it being fine. You still need to check frequent (before and after) BPs and HR of course.

Tele monitoring is most important when you're looking to convert someone from afib to SR or if you're looking to reduce HR.

Of course each facility has their own protocol which should be followed.

WOLFE, BSN, RN · May 1, 2006

Hello, in regards to iv beta blocker we have an extensive protocol from how...mixing it in ns to be hung on an imed pump not just on a syringe pump...vital signs...must be on tele and administered by a tele certified rn...tele monitor tech called and aware of admin to watch for changes as well...

AndyB · May 1, 2006

Thank you all. I'm thinking that during acute care a patient should be monitored while getting IV beta blockers. While on the floor this may not always be the case and the best procedure is to follow your hospitals policy.

NHavenRN · May 1, 2006

I just had a pt this weekend - I work on a med floor - 27 yo with no cardiac history whose BP kept soaring out of control - the docs and I put her on tele before they pushed beta blockers, just so we could monitor her HR more closely than I'd be able to (with 6 pts, that kind of 1:1 care just isn't possible!). I don't know that that's our floor's policy (we don't have one, since we don't usually have these pts!), but it felt appropriate.

rjflyn, ASN, RN · May 1, 2006

That is if they get admitted at all. We frequently have patients come in for non BP complaints who just happen to have hypertension. Sometimes they get something and sometimes they dont. Its a crap shoot. If they get anything typically it PO.

Well, if a pt came into the ED with a BP of 220 systolic, they'd probably be admitted to a monitored bed, so they'd have a monitor.
If this were to happen on a med surg floor? I don't know. I would think so, but i dont have a good reason why

As far as IV beta blockers generally in the ER if its being ordered the patient is generally already on the monitor. I can only think of a time or two in 18 yrs where I have seen it ordered on a non-monitored patient or said order didnt include to place patient on the monitor.

RJ

brianaerrn · May 1, 2006

I would personnally not feel comfortable pushing IV Beta blockers without a cardiac monitor. I believe this is also hospital policy where I work.

LillyaRN · Jan 3, 2008

The subject recently came up at my hospital to change the policy to allow IV beta blockers for unmonitored patients. I'm not sure exactly how great the risk might be. Any thoughts on worst case scenario?

MIA-RN · Jan 3, 2008

I think where I work the first dose has to be given under tele monitoring but subsequent doses don't have to be as long as the patient tolerated it well.