HTN urgency with IV Beta Blockers

[AndyB]

Just making sure that my previous workplace did not instill any bad habits in me. Is cardiac monitoring needed for all patients who get an IV beta-blocker for asymptomatic HTN control? No cardiac hx otherwise and a HR in the 70's. I have done this unmonitired in the past but I have stuck around for a bit and kept tabs on their HR.

[GrumpyRN63, ADN, RN]

Our pts are routinely put on IV beta blockers post op. We are not a monitored unit. The hospital policy has changed, now We monitor first dose response w/ lifepack (satellite monitor) and then given s monitoring, hold parameters in place.

We use to monitor them w/satellite w/each dose, but that was for a new onset event, usually leading to the pt getting tx to a tele bed

Years ago it was very infrequent, pts were few and far between, now, half of the patients are on IV lopressor, in most cases just as a continuation of anti- HTN or Afib meds, it really doesn't warrant a tele bed, as these are not new events and are converted to p.o. usually the next day --or few if prolonged NPO

[FireStarterRN, BSN, RN]

Our protocol is that if it's a new medication for the pt, then they must be hardwired. If it's a replacement med because they are NPO, then they can be on Med/Surg.

[TiredMD]

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.

No headache? No elevated creatinine? No eye findings? Normal EKG? If this was just leg pain after a lifting injury, and the BP was incidentally found, I would never have admitted him.

Go home, see you primary care doc for BP followup. 185/105 isn't very impressive if there's no evidence of end-organ damage, and likely if he was in acute pain that's higher than his baseline. Chasing something like that with Lopressor seems like a waste of everyone's time.

[50isthenew30]

Just went thru 2 nights with a pt in for potential impending DTs, altho absolutely no agitation, long story short we were giving IVP labetolol and enelapril along with his morphine, librium, and methadone. BP would still go up as high as 192/119, then drop to 90's over 60's, guy was under care of our teaching docs, they were comfortable enough with the situation, boy was I glad our protocol requires a monitor for those drugs:redbeathe. Especially at 0230!!

[Virgo_RN, BSN, RN]

My Davis says that EKG monitoring is "required" for IV metoprolol.

[UM Review RN, ASN, RN]

We require monitoring and a tele nurse to give IV Lopressor, but we cannot give IV Labetolol. The patient has to go to the CCU for that.

[50isthenew30]

Wow--CCU for IVP on these meds...and to think I felt like my unit was a "less acuity" floor--we are called Advanced Progressive Care, but since we document like med/surg (ie q shift assessment is our default), I never felt like APCU was anything out of the ordinary...

Now I feel like I earned my night off!:cheers:

[KristiePDX]

Had a Pt last noc with BP 228/112. MD ordered metoprolol 5mg IV Q2h PRN SBP >220 or HR > 110. HR was in the 90's but upon assessing her rythem over a period of time, she was IN AND OUT OF 3rd DEGREE HB several times during my shift for less than a minute a pop. Even had a 7.51 second pause p waves only. I would have never had known that unless she was on tele. No way you could get me to push that med! I called MD and the order was promptly DC'd.

At my facility tele is required for all IV cardiac meds.

[TiredMD]

. . . she was IN AND OUT OF 3rd DEGREE HB several times during my shift for less than a minute a pop. Even had a 7.51 second pause p waves only.

Oh my God.

Thank God you dodged that bullet.